Health Information Management

Q&A: Which revenue code is used for IV fluid given in ED?

APCs Insider, July 31, 2015

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Q: If IV fluid such as sodium chloride is given in the ED, should the revenue code be 250 (pharmacy) or 450 (emergency room) for the fluid?
A: The answer is "it depends." Revenue codes are used for several purposes other than to report services on the claim. The important question here is—where does the cost for the IV fluid originate? If the pharmacy is purchasing the fluids, then the cost is being allocated to the pharmacy and you should report revenue code 250 or 258 (pharmacy IV solutions).
The revenue code maps to a department in the general ledger, which then maps to the cost report. CMS uses the Medicare cost report to determine what it costs a provider to provide the supplies and services. It is important to have these mappings correct in order to ensure that the cost and revenue match.
The fluid may be stocked in the ED (and other departments) for quick access, as patient care can be negatively affected if the fluid is not immediately available. But where the fluid is actually stocked is not necessarily an indicator of which revenue code should being used.
Many facilities make the pharmacy responsible for the cost of the IV fluids, but because of the large volume required to be stocked in the facility for patient care, there may be stock in the central supply/materials management department, each nursing department, the ED, surgery, etc. But the bottom line is that the cost is going to pharmacy (in our example) so the revenue code would map to the pharmacy (e.g., 258).
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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