I believe we may be coding our IV administration wrong. I need help!
Our Urgent Care bills like a family practice. If a patient comes in and we administer an antibiotic for 1 hour and then another antibiotic runs for 35 mins. and then we push a pain medication and we are giving the patient normal saline for hydration (45 mins), we would code 96365,97366, 96375 and 96361 and the codes for the antibiotics and pain medication.
We do not charge for the saline and I am wondering if we should be using 96367 and 96378 codes. I need some clarification. We have never used 96367 and 96368, as I was told those are3 only used in the hospital? So, we have not been using them since we bill from the office setting. Seems rather confusing to me. Any he3lp from the experts would be very much appreciated.
The IV antibiotic is OK it is your initial IV service, 1 unit initial, 1 unit additional because of the 35 minutes. IV push for the pain med OK too. The IV hydration can only be charged for separatley if it is given independently of the IV antibiotic, separate site, not likely though because you need the saline to keep the antibiotic from burning the patient, so my guess it is used to facilitate the IV antibiotic. Start and stop times are critical if not recorded accurately and consistently you lose the revenue for the IV services altogether.
If you continue to run the Saline for hydration purposes after the IV antibiotic is stopped it is possible to bill that as an additional unit of IV hydration (not new) if the medical record supports it and the physician indicates he/she was also treating dehydration. Need to record the total run time of this service as well to determine if you can bill the addtional unit. And you need to back out the IV antibiotic run time from the hydration to determine that you have additional units to bill.
If the patient has an IV antibiotic running for 1 hour than a different IV antibiotic hung and running for 35 mins followed by an IV push pain med the codes should be 96365, 96367 and 96375
If the hydration running 31 mins after end time of the second antibiotic and the patient has a valid diagnosis for the hydration then you can charge a 96361
As for codes for the facility (hospital) the only code that is facility based is 96376 page 488 in the AMA cpt book 2010
hope this helps
Robin Ingalls-Fitzgerald CCS, CPC, FCS, CEMC, CEDC