hrsmith23
New
Is there someone out there that does Endocrinology coding and regularly performs Water Deprivation Testing that can tell me what CPT codes I can use to get reimbursed for this very time consuming test. Below is our procedure protocol, but I have no idea what I could bill for this. Thank you for the help in advance.
PROCEDURE
1. Obtain urine sample (explain to empty the bladder fully with each void)
• Record amount, obtain specific gravity (if specific gravity is >1.020 at any point during the test call physician before continuing with test.)
• Save as specimen TIME 0â€�and send urine for urine sodium and osmolality
2. Obtain patient's weight and height
3. Obtain baseline vitals including orthostatic blood pressure and pulses with five minutes between each position.
4. Place patient in a semi-recumbent position (kept patient in this position as much as possible)
5. Select and obtain IV site.
6. Draw BASELINE
• Serum sodium and osmolality
• Obtain plasma AVP (vasopressin) level in an ice purple top tube, place on ice and take to lab as soon as possible (may be kept on slushed ice for a maximum of 2 hours).
7. Call the Physician and stop the test and follow the instructions below if any of the following occur:
• If greater than 3% of body weight has been lost
• If serum sodium levels exceeds 145 mmol/l
• If serum osmolality exceeds 300 Osm/kg of water
• If urine osmolality reaches a plateau (less than 10% change over three consecutive measurements)
• Significant orthostatic blood pressure and/or pulse changes are observed
• Any evidence of cardiovascular instability
8. At TIME +1hr Obtain:
a. Weight
b. Orthostatic blood pressure with pulse
9. At TIME +2hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Urine sample- record amount, obtain specific gravity and send for a urine osmolality and sodium.
• Serum osmolality and sodium (Waste 3ml before each draw and flush saline-lock with 10ml sterile normal saline after each lab draw)
10. At TIME +3hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
11. At TIME +4hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Urine sample- record amount, obtain specific gravity and send for a urine osmolality and sodium.
• Serum osmolality and sodium (Waste 3ml before each draw and flush saline-lock with 10ml sterile normal saline after each lab draw)
12. At TIME +5hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
13. At TIME +6' Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Urine sample- record amount, obtain specific gravity and send for a urine osmolality and sodium.
• Serum osmolality and sodium (Waste 3ml before each draw and flush saline-lock with 10ml sterile normal saline after each lab draw)
14. At TIME +7' Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Serum osmolality and sodium
15. If any of the following occurs: 3% of body weight has been lost, serum sodium levels exceeds 145; or serum osmolality exceeds 300, urine osmolality reaches a plateau, significant orthostatic blood pressure and/or pulse changes
• Obtain plasma AVP (vasopressin) level in an ice purple top tube, place on ice and take to lab as soon as possible (may be kept on slushed ice for a maximum of 2 hours).
• Administer
o Subcutaneously AVP:5 units or dDAVP (desmopressin):1 mg
• Obtain weight and urine every hour for urine osmolality and specific gravity, call physician with results for further orders (to remain NPO or when to start oral rehydration) will usually continue NPO status until the urine osmolality stops going up, or if urine becomes appropriately concentrated (600).
• Once rehydration occurs and vital signs stabilize, remove IV and discharged patient at this time.
16. Stop test at +7 hours or 1600, if none of the above occurs, call physician, remove IV and discharge patient if in stable condition
Heather Smith, CPC
PROCEDURE
1. Obtain urine sample (explain to empty the bladder fully with each void)
• Record amount, obtain specific gravity (if specific gravity is >1.020 at any point during the test call physician before continuing with test.)
• Save as specimen TIME 0â€�and send urine for urine sodium and osmolality
2. Obtain patient's weight and height
3. Obtain baseline vitals including orthostatic blood pressure and pulses with five minutes between each position.
4. Place patient in a semi-recumbent position (kept patient in this position as much as possible)
5. Select and obtain IV site.
6. Draw BASELINE
• Serum sodium and osmolality
• Obtain plasma AVP (vasopressin) level in an ice purple top tube, place on ice and take to lab as soon as possible (may be kept on slushed ice for a maximum of 2 hours).
7. Call the Physician and stop the test and follow the instructions below if any of the following occur:
• If greater than 3% of body weight has been lost
• If serum sodium levels exceeds 145 mmol/l
• If serum osmolality exceeds 300 Osm/kg of water
• If urine osmolality reaches a plateau (less than 10% change over three consecutive measurements)
• Significant orthostatic blood pressure and/or pulse changes are observed
• Any evidence of cardiovascular instability
8. At TIME +1hr Obtain:
a. Weight
b. Orthostatic blood pressure with pulse
9. At TIME +2hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Urine sample- record amount, obtain specific gravity and send for a urine osmolality and sodium.
• Serum osmolality and sodium (Waste 3ml before each draw and flush saline-lock with 10ml sterile normal saline after each lab draw)
10. At TIME +3hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
11. At TIME +4hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Urine sample- record amount, obtain specific gravity and send for a urine osmolality and sodium.
• Serum osmolality and sodium (Waste 3ml before each draw and flush saline-lock with 10ml sterile normal saline after each lab draw)
12. At TIME +5hr Obtain:
• Weight
• Orthostatic blood pressure with pulse
13. At TIME +6' Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Urine sample- record amount, obtain specific gravity and send for a urine osmolality and sodium.
• Serum osmolality and sodium (Waste 3ml before each draw and flush saline-lock with 10ml sterile normal saline after each lab draw)
14. At TIME +7' Obtain:
• Weight
• Orthostatic blood pressure with pulse
• Serum osmolality and sodium
15. If any of the following occurs: 3% of body weight has been lost, serum sodium levels exceeds 145; or serum osmolality exceeds 300, urine osmolality reaches a plateau, significant orthostatic blood pressure and/or pulse changes
• Obtain plasma AVP (vasopressin) level in an ice purple top tube, place on ice and take to lab as soon as possible (may be kept on slushed ice for a maximum of 2 hours).
• Administer
o Subcutaneously AVP:5 units or dDAVP (desmopressin):1 mg
• Obtain weight and urine every hour for urine osmolality and specific gravity, call physician with results for further orders (to remain NPO or when to start oral rehydration) will usually continue NPO status until the urine osmolality stops going up, or if urine becomes appropriately concentrated (600).
• Once rehydration occurs and vital signs stabilize, remove IV and discharged patient at this time.
16. Stop test at +7 hours or 1600, if none of the above occurs, call physician, remove IV and discharge patient if in stable condition
Heather Smith, CPC