Pediatric Coding Alert

To reap the full benefits of in-office hydration therapy, such as increased patient convenience and revenue, follow six steps to ensure that you claim all permissible services. Bill Based on Documented Infusion Duration Report intravenous (IV) infusion for dehydration based on the length of the infusion. For the first hour, you should use 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour), says Jeanne Smith, reimbursement specialist for Madrona Medical Group, a large multispecialty group, which includes 14 pediatricians, in Bellingham, Wash. Bill subsequent hours with +90781 ( each additional hour; up to eight [8] hours [list separately in addition to code for primary procedure]). "Code 90781 is an add-on code and therefore can never be billed alone," Smith points out. When the infusion lasts more than an hour but less than a full additional hour, append modifier -52 (Reduced services) to 90781 to indicate that the time beyond the first hour was less than one hour, according to CPT Assistant. For instance, a parent brings a child who has vomiting (787.03), a fever (780.6 ) and dehydration (276.5) into a pediatrician's office. After evaluating the patient, the doctor decides to treat the child's dehydration in the office. The total documented duration of the infusion is one and a half hours. For the first hour of infusion, report 90780. For the additional 30 minutes, assign 90781-52. Report E/M in Addition to Infusion The infusion codes are for performing the service only, CPT Assistant states. They do not include the physician's evaluation of the patient prior to providing hydration. If the physician determines that the patient needs hydration therapy the same day as the patient encounter, bill both the E/M code (appended with modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and the infusion codes (90780-90781), Smith says. For example, a patient presents to a pediatrician's office with diarrhea (787.91), nausea with vomiting (787.01) and abdominal pain (789.0x). The pediatrician evaluates the patient's symptoms and diagnoses infectious gastroenteritis (009.0). The patient is dehydrated from the inability to keep fluids down, so the pediatrician administers an IV infusion for one hour. The pediatrician examines the patient's symptoms to determine the proper course of treatment, meaning he or she provides a significant, separate E/M service. Bill the appropriate-level office visit (99201-99205, New patient; 99211-99215, Established patient), based on the level of history, examination and medical decision-making documented. Append the E/M code with modifier -25 to show that the pediatrician performed a separately identifiable service from the infusion. For the infusion, report 90780. Link 9921x to 009.0, and 90780 to [...]