Health Information Management

Report 90760 for IV infusion to treat gastroenteritis

APCs Insider, December 8, 2006

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Report 90760 for IV infusion to treat gastroenteritis

QUESTION: A patient presents to the ED with vomiting and stomach pain. The physician orders 1000 ml of normal saline (NS), administered over an hour. The final diagnosis is gastroenteritis, with no mention of dehydration. Should we report the IV using 90760 (IV infusion, initial, up to one hour), or 90765 (IV infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to one hour), because the physician has not documented as hydration?

ANSWER: Patients present to the ED with a variety of conditions that require hydration. Hydration solution may include a combination of sugar and carbohydrates (for energy), electrolytes, and trace elements. The solution may contain all or some of these substances, depending on the patient's condition. Electrolytes include sodium, potassium, chloride, phosphate, calcium, and magnesium. Trace elements include zinc, copper, manganese, and chromium. Electrolytes and trace elements are important for maintaining almost every organ in the body. Providers typically document these substances as NS .9%, ringers lactate, and D5W.

Although the physician does not document the word "hydration" in the medical record, based on the definition listed above, the appropriate initial drug administration code is 90760. The reason that this IV is billable is because the provider administered it to treat the patient's condition (as documented by the physician), not because it's part of a protocol or an order to keep vein open (KVO). The elements that make this service billable are the physician's order, the nursing documentation, and the fact that it is provided to treat a condition.

Because these are "time-based" codes, emphasize the need to document the clinical time frame. This documentation will allow a coder to determine the IV solution initiation and end times, which validate proper use of 90760 and 90761.

Note that beginning January 1, 2007, CMS will pay for the additional hours code 90761 at an unadjusted national payment rate of $24.11. Also note that the 2007 CPT Manual removed the "up to 8 hours" portion of the narrative description of 90761.

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