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When to charge drug administration services

APCs Weekly Monitor, May 5, 2006

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When to charge drug administration services

QUESTION: I audit ED procedures and am confused about how to charge for an IV (90760) that is initiated in the ambulance en route to the ED. Is it possible to bill for this service? Also, if a patient is being treated in the ED and gets a normal saline IV just to keep the vein open (KVO), can we charge 90760?

ANSWER: To answer the first part of the question, you can bill for an IV initiated in the ambulance en route to the ED. This was addressed in CMS Transmittal 785, issued December 16, 2005, effective January 1, 2006, in section E (infusions started outside the hospital). Here is the reference:

Hospitals may receive Medicare beneficiaries for outpatient services who are in the process of receiving an infusion at their time of arrival at the hospital (e.g. a patient who arrives via ambulance with an ongoing intravenous infusion initiated by paramedics during transport). Hospitals are reminded to bill for all services provided using the HCPCS code(s) that most accurately describe the service(s) they provided. This includes hospitals billing C8950 or C8954 for the first hour of intravenous infusion that the patient receives while at the hospital, even if the hospital did not initiate the infusion, and HCPCS codes for additional hours of infusion if needed.

Once the patient arrives at the hospital, the ED physician should confirm the medical necessity of the IV and document an order for it in the patient's record.

To answer the second part of your question, KVO is not considered hydration services and this order does not meet the criteria for billing C8950 or 90760. Hydrating the patient is used to treat a wide variety of medical conditions or to prevent the patient from dehydrating.

KVO is an order to keep the vein access open "just in case," and it is inappropriate to bill an infusion code when medical record documentation states KVO only. CMS wants providers to document medical necessity with drug administration claims. Per Medicare standards, KVO does not meet the criteria.

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