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infusion, hydration, pushes? help w/ chart note

  1. #1
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    Everett, WA
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    Default infusion, hydration, pushes? help w/ chart note
    Medical Coding Books
    Need some wise eyes to take a look at this note: Patient seeking acute care treatment for headaches comes in for treatment at the physician's office: Here's a paragraph extraction and am stalled at seeing the submitted codes of 96360, 96374, 96365.

    IV access was established at 10:12 AM and about 200 cc of IV normal saline was infused over the course of 30 minutes. An injection of Toradol 30 mg and Phenergan 25 mg were both injected intravenously. Patient complained of ongoing nausea and HA had resolved. Then an IV bag containing 25 mg of Phenergan diluted in 100 cc of normal saline was attached and infused over 30 minutes starting at 10:45 AM and ending at 11:17 AM. HA and nausea resolved.

    Insurance is commercial coverage. 96360 for hydration is really not applicable in this situation, is it? Nothing in the notes about patient being dehydrated and it appears to be used to facilitate the drugs? So it looks like two IV pushes for the Toradol and Phenergan along with the 96365 for the IV bag diluted with the phenergan?

    AND I'm needing this for my own education, why would not 96365, 96367 be appropriate?
    ---Suzanne E. Byrum CPC

  2. Default
    I don't think the diagnosis has to be dehydration in order to charge for hydration as long as there's an order and you can establish medical necessity. However, you cannot charge for hydration if it's TKO (to keep the line open.) Also, hydration has to be 31 minutes or more in order to charge for it. To me it sounds like the codes should be 96365 for the infusion of Phenergan, which would be the primary code because infusions are primary to IVPs. Then there would be a 96375 for the Toradol because it's secondary to the infusion. Then I would charge a 96376 for the IVP of Phenergan because it's an IVP of the same drug that was infused.

    Haley Sutton, CPC, CPMA
    Last edited by haleymw19; 12-27-2011 at 03:30 PM.

  3. #3
    Location
    Everett, WA
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    Default
    Haley, thanks for your input on this. Since this service was provided in the doctor's office we are not allowed to charge for the 96376 according to CPT directives, so is there another way we could account for the IVP Phenergan? ---Suzanne

  4. Default
    That I'm not sure of. I work in a hospital outpatient infusion center and that's how we charge for it. Sorry, wish I could help!

  5. #5
    Location
    Everett, WA
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    886
    Default
    Again, Haley, thank you for your time in answering and I do very much appreciate it! Perhaps I'll go with the 96365 and the 96375x2? ---Suzanne

  6. #6
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    Everett, WA
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    Default
    Looking for additional thoughts to what has been mentioned. Thank you, people!

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