Oncology & Hematology Coding Alert

Question: How should I code the following scenario for a December date of service (we're still dealing with the appeals with Medicare): The patient had chemotherapy and returned the next day with diarrhea, syncope, and elevated glucose. The physician hydrates the patient with 250 cc of normal saline over two hours.


Arkansas Subscriber
Answer: To avoid a denial, you should focus on the appropriate diagnosis - dehydration. Snag: The physician must state "dehydration" in the documentation for you to assign the proper code.

Explain to your physician that because you can't assume a diagnosis, you'll have to report 787.91 (Diarrhea) or another symptom, even though payers often require the more definitive 276.5 (Volume depletion), which specifically includes dehydration.

If your doctor forgets to document dehydration, he can insert an addendum to update the patient care record. Remember: Auditors don't want to see addenda written just to gain reimbursement, but in this case the chart supports dehydration as an accurate diagnosis.

To report the procedure, use three codes:
  J7050 - Infusion, normal saline solution, 250 cc
  90780 - Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour
  +90781 - ... each additional hour, up to eight (8) hours (list separately in addition to code for primary procedure).