Pediatric Coding Alert

In an effort to infuse their offices with added reimbursement, many pediatric coders are making fraudulent mistakes when reporting 90780-90781. Make sure you're not sucking the legality out of this extra revenue and risking wearing orange. With 90780 (Intravenous infusion for therapy/ diagnosis, administered by physician or under direct supervision of physician; up to one hour) and +90781 ( each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) ranking in the list of the top-50 most-performed pediatric procedures, you probably encounter these codes regularly. But do you really have these codes down pat? Many coding experts recommend reporting prolonged services in addition to the rehydration codes, a practice that CPT specifically disallows. In addition, you may wonder about the correct combination of infusion codes to assign. So inject your practice with a coding review by trying your hand at an infusion scenario and answering the questions that follow. Suppose a grandmother brings to a pediatrician's office her 10-year-old grandson who has gastroenteritis. The physician documents history, evaluation and medical decision-making that equate to a level-five established patient office visit. Aregistered nurse under a pediatrician's supervision administers an intravenous (IV) infusion of 33 mg of Phenergan to treat the child's nausea and vomiting and 500 ml of 5 percent dextrose/normal saline for three hours to rehydrate the patient. Although the pediatrician is not in constant attendance, she checks on the patient every 15 minutes. 1. How Should You Report the E/M Service? In this example, the pediatrician performs a level-five established patient office visit, which you should bill with CPT 99215 (Office or other outpatient visit for the E/M of an established patient physicians typically spend 40 minutes face-to-face with the patient and/or family), says Dalrona Harrison, RN, BS, CCS-P, CPC, approved American Academy of Professional Coders Professional Medical Coding Curriculum instructor and coding manager for Via Christi Medical Management in Wichita, Kan. The E/M service involves the history, evaluation and medical decision-making, which led the pediatrician to determine that the patient needed IV infusion. To indicate that the history, evaluation and medical decision-making involved with 99215 are significant and separately identifiable from the minor E/M included in 90780-90781, you should append modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 99215. "The modifier denotes the work that was necessary based on the patient's condition and then resulted in the administration of IV fluids and drugs," Harrison explains. 2. Which Codes Should You Use for the Infusions? After reporting the E/M service, you should consider coding for the fluid administration. For the first hour of infusion, you should use 90780, [...]