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Report 90774 or 90775 as appropriate for bolus of normal saline

APCs Weekly Monitor, February 23, 2007

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Report 90774 or 90775 as appropriate for bolus of normal saline

QUESTION: If a patient presents to the ED with nausea only (no vomiting) and receives a bolus of normal saline, can we consider this bolus to be therapeutic? There is no documentation which states that the patient is dehydrated. As non-clinical staff, we have trouble making this decision. Is it possible that a fluid bolus can make a person without dehydration "feel better" overall?

ANSWER: According to the answer to question 23 in AHA Coding Clinic for HCPCS, volume 6, number 3, 3rd quarter, 2006, it is appropriate to report 90774 for a bolus or IV injection of pre-packaged fluids such as lactated ringers. Consider fluids (whether pre-packaged or mixed) and specific drugs as therapeutic, unless staff use them as a carrier solution or to keep the vein open.

We concur with the AHA answer to report 90774 or 90775 as appropriate for an IV injection of pre-packaged solutions for a medically necessary reason. Note that in order to report 90774/90775, medical record documentation must include the time requirement of 15 minutes or less, or it must indicate that the healthcare provider was present for the entire injection.

The clinical indications or medical necessity for hydration is not always "dehydration" per se. We recommend discussing various clinical scenarios with the ED medical director to learn the clinical rationale for the IV solutions.

In specific cases, your charge capture staff and/coders can prompt or query physicians for the clinical indication when it is not present in the orders or the dictated ED report.

Expanded answer to February 23 APCs Weekly Monitor

The question posed in the February 23 APCs Weekly Monitor "Report 90774 or 90775 as appropriate for bolus of normal saline" did not specify whether the bolus was an IV push or an IV infusion. Often hospital documentation states the term "bolus," either for an IV push or an IV infusion.

Our answer was based on the bolus injection being an IV push. However, we do not want to give the impression that hospitals should assume that the term "bolus" automatically means IV push. If the documentation is unclear, then the hospital must obtain clarification to determine whether a medically necessary "bolus" of solution is truly a medically necessary IV push of the solution or an IV infusion of the solution.

Another scenario that may occur is that a provider administers an IV push bolus first, followed by an infusion of the same solution. In this case, you can bill both the IV push and the hydration infusion as long as they were medically necessary and properly documented.

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