Health Information Management

Epinephrine via endotracheal tube

APCs Insider, December 18, 2003

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THE MONITOR'S ADVISORY BOARD

Keith Siddel
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
RHIA, CCS, CPCH
president
Health Revenue Assurance Associates

Cheryl D'Amato
RHIT, CCS,
director, health information management
HSS, Inc.

Julie Downey
CPC, CPC-H,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino
RHIT, CPUR,
Independent
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Jeannie Gourgeot
RT, RHIT,
Director of HIMS
St. Joseph's Medical Center

Synthia L. Miller
CCS
Corporate Compliance
Analyst

Julia R. Palmer
MBA, RHIA, CCS,
president, Health Information Management Division
HRM

Valerie Rinkle
MPA
revenue cycle director
Asante Health System


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Today's topic

This week, our experts explain what codes you can and can't use for medications administered via an endotracheal tube in the ED.



APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of both Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and APC Answer Letter, which answers readers' questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at himinfo.com. Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and its corresponding answer are delivered to your inbox every Friday.


TODAY'S TOPIC: Epinephrine via endotracheal tube

QUESTION: If a patient in the ED receives epinephrine or any other medicinal substance via an endotracheal tube, do you code this as 90784? If not, what is the correct CPT code?

ANSWER: CPT code 90784 is defined as "Therapeutic, prophylactic or diagnostic injection, intravenous." In your example, the patient is clearly not receiving the medication through a vein; therefore, 90784 would not be appropriate. The medication is not being administered through a subcutaneous, intramuscular, or intra-arterial method either, so 90782 or 90783 would also not be appropriate.

One could argue that 90799 "Unlisted therapeutic, prophylactic or diagnostic injection" may be appropriate, but this argument would depend upon defining the delivery action as an "injection." Since this medication is ultimately delivered to the patient's lungs for absorption, there is little difference between this and inhalation administration. Although epinephrine or any other medication may be drawn up in a syringe, it is still being delivered internally in a liquid form for absorption. In the ED setting, most medications administered orally or via inhalation cannot be billed to Medicare because it considers these medications to be self-administered or part of the procedure. In this case, however, since epinephrine is not normally administered orally or via inhalation, it would not be considered self-administered and therefore could be billed to Medicare.

The delivery of medication via endotracheal tube should not be separately coded or billed, but the charge for the medication can be billed to any payer, including Medicare. This service can also be accounted for through appropriate E/M level assignment, assuming proper documentation is present. Depending on the structure of your E/M charges in the ED, these services may increase the visit level.


PAY PER VIEW: Solutions for drafting Stark compliant physician contracts

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Click HERE to read more. The cost is $10. Strategies for Healthcare Compliance subscribers have free access via their online subscriptions.

ASK THE EXPERT: When assigning codes for lab tests or x-rays, can you code a symptom that meets medical necessity requirements using the nurse's notes? Is it acceptable to code a diagnosis from a medication record, such as an emergency room record, that lists only the name of the medicine?

Click here for the EXPERT'S answer.


Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


EDITOR'S CHOICE

Big changes are coming in medical record coding

ICD-10-CM and ICD-10-PCS coding, a series of seven alpha and numeric systems, are on the horizon. It may be two years before you are required to implement them, but hospitals have to start getting ready now. Changing to ICD-10-CM for diagnosis and ICD-10-PCS for procedures will impact every area that uses coded data in each clinical setting, including HIM, information technology, finance, chargemaster maintenance, and patient registration. They are going to need new internal forms and new computer software. They will also have to train endless numbers of people on the staff, from the coders and billers to the clinical and ancillary services staffs.

We've designed an audioconference to help you learn what the two systems will entail, what the future requirements of the systems will be, and what they need to do to prepare for implementation.

Join us for ICD-10: What you need to do NOW to get ready, on Tuesday, January 6, 2004, beginning at 1 p.m. Eastern. For information or to register,CLICK HERE or call our Sustomer Service Department at 800/650-6787. Be sure to mention Source Code EZ23984B.


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