Pediatric Coding Alert

Replace hydration therapy's '8' with a '6'

You can seamlessly transition to the new infusion therapy coding method without confronting a denial--if you know these four rules.

CPT Codes 2006 replaces its universal infusion codes with six new codes. “You should assign the new CPT codes based on the infused substance--non-medicine (90760-90761) or medicine (90765-90768),” says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J. Instead of using a single code set (90780-90781), CPT breaks intravenous therapy into two areas:

1. 90760-90761 for hydration

2. 90765-90768 for therapy, prophylactic and diagnostic administration. Use 90760-90761 for Saline Solutions To avoid invalid-code denials in 2006, you should report hydration IV infusion with two time-based CPT codes. “Use 90760-90761 for IV infusion of saline and glucose-saline solutions,” Scott says. In these cases, staff members administer a prepackaged fluid and electrolyte solution to hydrate the patient. Caveat: These codes require direct physician supervision, which means the pediatrician must be in the office or the hospital, but not necessarily in the exam room or bedside, throughout the procedure.

The therapy’s time further determines the correct hydration therapy code(s). If the service is greater than 15 minutes, you should report the first hour of hydration infusion with 90760 (Intravenous infusion, hydration; initial, up to one hour). If the pediatrician directly supervises the therapy for an additional 30 minutes, you should also report +90761 (... each additional hour, up to 8 hours [list separately in addition to code for primary procedure]).

Important: Base hydration time only on the infusion’s administration time. “Services leading up to and concluding the infusion have been included in the infusion service code and are not separately reported,” states the AMA in CPT Changes 2006: An Insider’s View. The codes also include line placement and supplies. But you may report a significant and separate E/M service with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

Old method: In 2005, you should have coded hydration therapy with a general CPT infusion code. The applicable codes would have been 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]). 
 
Do this in 2006: A pediatrician directly supervises an IV infusion of 500 ccs of normal saline solution to a patient with diarrhea and vomiting. Documentation states the infusion administration occurs from 2:20-3 [...]