Primary Care Coding Alert

Resolve to break down IV infusion therapy based on the bag's contents, not insurer

You can start 2006 off on the right foot by submitting flawless hydration and medicine infusion claims--just be sure you are using these newly updated guidelines.

CPT 2006 replaces the 2005 universal infusion codes with six new codes. Similar to last year's G code structure, -the new CPT codes make the distinction between the reasons the physician gives the fluids--hydration (90760-90761) versus treatment (90765-90768),- says Patricia Davis, CPC, business office supervisor at Middlesex Health System Primary Care in Middletown, Ct. Instead of using a single code set (90780-90781), CPT breaks intravenous therapy into two buckets:

- 90760-90761 for hydration
- 90765-90768 for therapy, prophylaxis and diagnosis. The new structure not only mirrors CMS- infusion codes G0345-G0350 but also replaces them. -The good news is that we can use the same therapy codes, regardless of insurer,- Davis says. In 2005, you had to use CPT codes for private payers and HCPCS codes for Medicare carriers. Let these three examples steer your infusion coding for 2006 claims. Look for 3 Details That Characterize 90760-90761 You can arrive at the correct therapy code if you identify the infusion's purpose, the FP's whereabouts, and the therapy's duration. Look for these three details in the following example to guide you in coding the scenario: 

Example 1: An FP directly supervises an IV infusion of 500 cc of normal saline solution to a patient with diarrhea and vomiting. Documentation states the infusion administration occurs from 2:20 to 3 p.m.

The infusion's purpose: Because the IV infusion is for hydration, you should consider two time-based CPT codes. Codes 90760-90761 describe IV infusion of a common pre-packaged saline solution, Davis says. In these cases, staff members grab the bag, hang it and hydrate the patient.

The FP's whereabouts: The above scenario specifically notes that the infusion occurs under direct physician supervision, which means the FP is in the office or the hospital, but not in the exam room or bedside, throughout the procedure. Therefore, the encounter meets CPT's 90760-90761 requirement of direct physician supervision.

The therapy's duration: The therapy's time further narrows down hydration therapy codes. If the service is longer than 15 minutes, you should report the first hour of hydration infusion with 90760 (Intravenous infusion, hydration; initial, up to one hour). If the FP directly supervises the therapy for an additional 30 minutes or more, you should also report +90761 (... each additional hour, up to 8 hours [list separately in addition to code for primary procedure]).

Solution: Because the IV infusion in the first example lasts less than one hour, you should report the service with 90760. 
 
Old method: In 2005, you should have coded hydration therapy with a [...]