Practice Management Alert

The doctor usually performs a level-3 or -4 service during these sessions

When a physician performs an injection, infusion or hydration, billers should always check to see if the physician also performed a separate evaluation and management service during the encounter.

Why? You will be able to bill for a separate E/M in most injection and infusion scenarios. -Anytime a separately identifiable and significant E/M service is provided, you can charge for both E/M and the injection/infusion/hydration codes,- says Kevin Arnold, CPC, a coding instructor with Health Information Services Outpatient Coding in Danbury, Conn. -Separate E/M services are very common with the injection/infusion/hydration codes. It would be rare not to have both.-

But in order to get E/M payment, you-ll need a hand from modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), says Michael Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED billing company in Stoneham, Mass.

Example: A pediatrician treats a 5-year-old with vomiting, diarrhea and signs of moderate dehydration. The physician discusses treatment options with the parents, initiates an IV and provides the patient with normal saline over one hour. The child's condition then stabilizes.

During the hydration, the physician is immediately available for any issues, and is in contact with and supervising the nursing staff.

The physician reassesses the child after the hydration and starts a trial of oral fluids. On this claim, Granovsky says you should:

- report 90760 (Intravenous infusion, hydration; initial, up to one hour) for the hydration.
- report the appropriate-level E/M code for the service from the 99211-99215 code set.
- attach modifier 25 to the E/M code to show that the E/M service was significantly separate from the hydration.

When you see a patient for a separate E/M service during the same encounter as an injection/infusion/hydration, there is technically no limit on the level of service you can report, Granovsky says. However, you have to make sure the services the physician performs, as reflected in the medical record, justify your level of service.

-Usually the nature of the presenting problem that requires infusion or injection will coincide with moderate medical decision-making,- Granovsky says. That means that most infusion/injection/hydration sessions will include a level-three or level-four E/M service.