Health Information Management

Q&A: Billing injections and infusions in the ED prior to surgery

APCs Insider, October 30, 2015

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Q: I have a question about billing infusion/injections in the ED prior to a decision for surgery for professional services. A patient comes into the ED with right lower abdominal pain. The physician starts an IV for hydration, gives pain medication injections, then does blood work and an MRI to rule out appendicitis. The blood work comes back with an elevated white blood count, so the patient is started on an infusion of antibiotics. Then the MRI results come in with a diagnosis of appendicitis. So a surgeon is called in to consult and take the patient to surgery.
Can we bill the infusions/injections prior to the decision for surgery? I realize that once the decision is made, then the infusion/injections are off limits and are all included in the surgical procedure. But up until that time, can the ED charge the infusions/injections? They are treating the patient’s symptoms and can’t assume the patient will have surgery until the decision is made by the surgeon.
A: In my opinion, yes. According to your scenario, all of those services were provided to an outpatient in the ED. Afterwards, the patient is admitted (becoming an inpatient), to receive surgery and the associated services. 
Editor’s note: Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, of Safian Communications Services in Orlando, Florida, answered this question.


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