Health Information Management

Epinephrine via endotracheal tube

APCs Insider, December 18, 2003

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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.

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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.

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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.


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