Primary Care Coding Alert

Question: A patient presents with nausea, vomiting and dehydration. How do you code for the evaluation, insertion of the intravenous (IV) injection and administration of fluids?

Anonymous Oklahoma Subscriber

Answer: According to Debra Pennay, CPC, practice manager, St. Marys Hospital Physician Services in Grand Junction, Colo., which manages several primary-care clinics, code the appropriate level of office visit, 99212-99215 (office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: ranging from a problem-focused to a comprehensive history, a problem-focused to a comprehensive examination and a straightforward medical decision to one that is of high complexity).

Then you would add 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour). If the IV takes longer than one hour, then code 90781 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; each additional hour, up to eight hours).

According to CPT, codes 90780 and 90781 encompass prolonged IV services and may not be used in addition to prolonged-service codes. They require the presence of the physician during infusion and are not to be used for intradermal, subcutaneous or intramuscular or routine IV drug injections. Pennay does point out, however, that even though the physician must be present for the infusion, the FP need not be physically present during the entire visit. In the clinics under St. Marys management, nurses and mid-level practitioners may take over after the physician has completed the IV. Either the mid-level practitioners or the physician continually monitor the patientrecording time, vitals and medications.

She reminds FPs not to forget to code for the medicines: J7042 (5% dextrose/normal saline [500 ml = 1 unit]); J7060 (5% dextrose/water [500 ml = 1 unit]); or J7070 (infusion, D-5-W, 1,000 cc).

Jane Goostree, CPC, an insurance specialist for Joachim Schmelle, MD, in Wichita, Kan., concurs with Pennay. When she asked Schmelle which medications he would use via the IV, he added J0780 (injection, prochlorperazine, up to 10 mg), which is used for Compazine, Contranzine, Compa-Z and Untrazine-10. The medications vary according to the physicians prescription, Goostree notes, but coding for the E/M visit and for the administration of the IV are 99212-99215 and 90780 and 90781, the latter if needed, respectively.

She does add, however, that most FPs would not be responsible for administering IVs. Most likely, the FP would stabilize the patient and admit him or her to the hospital.