Revenue Cycle

Understand the issues: RACs and IV hydration audits

Recovery Auditor Report, November 25, 2009

Editor’s note: This article is excerpted from the November 18 issue of
Some of the issues CMS has already approved for review under the RAC permanent program are straightforward. However, the IV hydration issue is one that lends itself to confusion and in turn, inaccurate reporting.

Simply put, you can only bill one unit of service per patient per date of service for IV hydration CPT code 90760. (CPT code 96360 replaced code 90760 January 1, 2009.) This is currently an approved issue for all RACs except DCS Healthcare, the RAC for Region A.

Unfortunately, it is not always as simple as it may seem on paper. For example, sometimes the transfer of a patient from one department can inadvertently trigger reporting of multiple units for this initial service, says Debbie Mackaman, RHIA, CHCO,regulatory specialist for HCPro, Inc.

Consider the following: A nurse in the emergency department (ED) starts IV hydration for a patient, which means coders can report one unit for that initial service. Then the physician orders observation services and the patient is moved to another area. Sometimes nurses administering services when the patient is in observation will mistakenly document an initial IV hydration service in an attempt to indicate this patient received the services during observation.

This is an example of incorrectly reporting two units of this IV hydration code for one date of service. “You can only report one initial hydration service per date of service regardless of where you provided that service,” Mackaman says.

“In the ER, the rules are clear that whatever date of service you started the IV hydration, that’s the date of service you report even when the service spans over to the next date,” Mackaman says. If the ED nurse never terminated the service, then the IV hydration is simply an ongoing service even after the patient is referred to observation, she explains.

Mistakes in reporting IV hydration units often result from a lack of communication. Because you already reported one initial service code in the ED, you should report only the add-on code to reflect the ongoing IV hydration service in observation, Mackaman says.

“There has to be communication among the nursing staff members and coders, who may be responsible for sending through charges between units,” she says. “They have to understand that they can only report one initial no matter where it started.”

Another potential reporting pitfall for IV hydration involves the fact that you may report only one initial service for the same IV site.

In a facility setting, there are specific guidelines regarding the hierarchy of these codes and which codes take precedence, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director of HIM and coding at HCPro, Inc.

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