Health Information Management

Q/A: Coding infusions to correct low potassium levels

APCs Insider, May 18, 2012

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Q. Can you help resolve an ongoing debate in our department? 

Patients come to our ED and infusion center for treatment. Their potassium levels are low after laboratory work is completed and our physicians prescribe IV potassium in addition to other treatments being administered. in the Emergency Department and our infusion center for treatment.

Should we report this as hydration or a therapeutic drug administration service?

A. This question has been a hotly debated during the past few years for two reasons—the CPT® definition of hydration and whether the potassium and fluid were mixed or prepackaged.
AHA’s Coding Clinic for HCPCS recently published a Q&A that addresses this scenario. The Q&A scenario involves a patient who presents with a low potassium level. The physician orders IV potassium to treat the patient.

Coding Clinic for HCPCS, First Quarter 2012, instructs coders to report this service with CPT code 96365 (intravenous infusion for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) for this infusion. Coding Clinic states:

It would be inappropriate to report the hydration code for this encounter because the infusion was provided primarily for the treatment of the patient’s low potassium level.

Report the appropriate code from the therapeutic/prophylactic/diagnostic drug administration codes for infusion of potassium to correct a low blood level. Be certain that you follow the facility hierarchy stated in CPT guidelines.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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