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Ask the expert: How should we report subsequent hydration after an initial therapeutic injection?

HIM Connection, June 11, 2007

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Q: We understand that we must report the codes for initial infusions when staff members administer an infusion of greater than 15 minutes, and report each additional hour codes for IV infusion intervals of greater than 30 minutes. However, we don't know which code to report for subsequent hydration after an initial therapeutic injection. What codes should we report in the following encounter?

Staff members administer a therapeutic IV push injection of Phenergan® and a hydration infusion of prepackaged fluids for 25 minutes. Per the hierarchy, we should report code 90774 for the IV push injection. For the hydration, can we report code 90761 if staff members do not administer the hydration for 31 minutes?

We are inclined to report codes 90774 and 90775, but are not sure, because the hydration was not ordered as a bolus or push. Please clarify.

A: Determine the initial drug administration service as the service that "best describes the key or primary reason for the encounter." In the scenario above, the primary reason for the encounter appears to be the IV push of Phenergan. Report this service using code 90774.

The drug administration guidelines define an IV push as an infusion of 15 minutes or less. Per the scenario described above, the subsequent hydration infusion time was only 25 minutes. This scenario does not support CPT code 90775.

In the scenario above, the 25-minute hydration infusion was administered as a separate, subsequent service after the initial IV push. A parenthetical notation in the CPT Manual directs the coder to "report 90761 to identify hydration if provided as a secondary or subsequent service after a different initial service [90760, 90765, 90774, 96409, 96413] is provided."

The guideline of "greater than 30 minutes" would apply if the hydration infusion in the scenario above was performed as "the additional hour(s), beyond the first hour of sequential infusion, as well as the second and subsequent hours for infusion, services can be reported if the intervals are greater than 30 minutes beyond 1 hour increments. (This also applies to the outpatient prospective payment system)."

Staff members would also have to document medical necessity to support reporting both the IV push and the IV hydration infusion.

References:

• American Medical Association, Current Procedural Terminology (CPT), 2007 Professional Edition, Ingenix, p. 373
• CPT Assistant, November 2005, pp. 3-6

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