ED Coding and Reimbursement Alert

You can now separately report drug/alcohol abuse screens It's official: CPT 2008 includes changes to the hydration, injection and infusion codes that will prevent their further use by physicians in the ED. However, next year's CPT book is also offering some new codes for tube procedures and behavior change counseling that ED coders can take advantage of. Check out this rundown of the CPT 2008 changes ED coders need to know about. CPT Puts Facility Requirements on Hydration Codes "We are seeing significant changes in the hydration, injection and infusion codes appearing in CPT 2008, disallowing use by physicians in the ED setting," confirms Michael Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass. Explanation: For 2008, CPT states, "Physician work related to hydration, injection and infusion services predominately involves affirmation of treatment plan and direct supervision of staff. These codes are not intended to be reported by the physician in the facility setting." Impact: Granovsky reports that in 2008, you won't be able to report the following codes in the ED setting: - 90760 -- Intravenous infusion, hydration; initial, 31 minutes to 1 hour - +90761 -- - each additional hour (List separately in addition to primary procedure) - 90765 -- Intravenous infusion, for therapy, prophylaxis or diagnosis (specify substance or drug); initial, up to 1 hour - +90766 -- - each additional hour (List separately in addition to code for primary procedure) - +90767 -- - additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure) - +90768 -- - concurrent infusion (List separately in addition to code for primary procedure) - 90769 -- Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to one hour, including pump set-up and establishment of subcutaneous infusion site(s) - +90770 -- - each additional hour (List separately in addition to code for primary procedure) - +90771 -- - additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure) - 90772 -- Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular - 90773 -- - intra-arterial - 90774 -- - intravenous push, single or initial substance/drug - +90775 -- - each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) - +90776 -- - each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) (Note: Codes 90769 through +90771 and +90776 are new for 2008). When you perform these procedures in the ED, Medicare considers the physician's supervision part of the E/M service. "Absent advice from other payers, you should consider this universal policy at this point based [...]