Primary Care Coding Alert

You may think intravenous (IV) hydration coding is just a matter of reporting 90780-90781, but that attitude will only dry out your revenue. You must know when to bill an E/M visit and how to navigate hospital admission coding if you want to receive optimal reimbursement for severely dehydrated patients.

FPs often send severely dehydrated patients to the hospital. However, many family practices are able to administer intravenous hydration within about one to three hours, says Shannon Joyce, MD, clinical faculty at St. Vincent Family Medicine Residency in Indianapolis. For the first hour, use 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour). Bill additional hours with add-on code +90781 ( each additional hour, up to eight hours [list separately in addition to code for primary procedure]). An add-on code is always performed in addition to the primary procedure and cannot be reported as a stand-alone code. Joyce also uses J codes for the supplies, such as J7030 (Infusion, normal saline solution, 1,000 cc), J7050 ( 250 cc) or J7042 (5% dextrose/normal saline [500 ml = 1 unit]), depending on the fluid and amount. Soak Up Reimbursement With E/M Codes Because the physician must assess the cause of dehydration, you can also bill for an E/M visit, Joyce says. For example, suppose a patient presents with vomiting, diarrhea and dizziness. The FP examines her, takes an orthostatic blood pressure and determines she has gastroenteritis and is severely dehydrated. The physician puts the patient on IV hydration for two hours. Code this visit with 90780 and 90781 and the appropriate-level E/M code. This visit type usually warrants a level-three E/M, Joyce says.

"Technically, the physician can bill an E/M as well, if performing a separately identifiable service," says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. But, she emphasizes, reimbursement for the E/M is carrier-specific. "Some payers query the office visit code whenever they receive a claim that has both a procedure and an E/M. They expect you to prove that you did something else."

Documentation is crucial: Write a good E/M note and make sure it is in a separate paragraph from the note about the hydration. The need for modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) also varies from carrier to carrier, Callaway says. Prolonged Services Codes Will Parch You Some coders mistakenly use prolonged services codes 99354-99355 with 90780-90781. This is incorrect coding because both the IV hydration codes and the prolonged services codes are by definition time-based, so the two cannot combine.

Nor should you use the [...]