Health Information Management

Report therapeutic, prophylactic, and diagnostic services as primary to hydration services

APCs Insider, April 25, 2008

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QUESTION: I have a question regarding the hierarchy of hydration, therapeutic infusions, and injections. Page 383 of the 2008 CPT Manual states that we should select the initial code using the hierarchy where chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services. In turn, these are primary to hydration services. Infusions are primary to pushes, which are primary to injections.
 
My specific scenario is as follows: A patient came into the ED with vomiting and with a diagnosis of vomiting and urinary tract infection. The patient received normal saline from 10:35 to 12:37 and an IV push injection of Zofran at 11:36.   
 
If I am interpreting the hierarchy correctly, I should report codes 90760, 90761, and 90775.  However, the 3M grouper edit states that CPT code 90775 is an add-on code and that I must report it in conjunction with 90765, 90774, 96409, or 96413. Upon questioning 3M Nosology, their reply was to report codes 90774 and 90761x2 because the Zofran, being a therapeutic injection, should be primary to hydration. My understanding is that infusions are primary to pushes. Can you please clarify?
 
ANSWER: CPT instructions state:
 
When these codes are reported by the facility, the following instructions apply.  The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy does not apply to physician reporting.
 
The hierarchy actually has two tiers. The first tier is the type of service: chemotherapy services, therapeutic/prophylactic/diagnostic services, and hydration services. The second tier is the administration route within those services: infusions, pushes, and injections. When deciding how to report the services provided, first choose the type of service, and then select the administration route within each service.
 
The hierarchy looks like this:
 
I.  Chemotherapy services
    A. Infusions
    B. Pushes
    C. Injections
II. Therapeutic/prophylactic/diagnostic services
    A. Infusions
    B. Pushes
    C. Injections
III. Hydration services
    A. Infusions (by definition, hydration cannot be a push or an injection).
 
In the example noted, normal saline is a hydration service and Zofran is a therapeutic/prophylactic/diagnostic service. Based on this hierarchy, therapeutic/prophylactic/diagnostic services are primary to hydration services. Therefore, you should report these services using with the following codes: 90774, and 90761x2.



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