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Heart Attack

Laura Posted Wed 26th of December, 2012 23:04:18 PM

pt was seen after hours 99050 critical care 99291 ekg 93000 and had various meds... suggestions on INTRAOSSEOUS INFUSION FOR 67 year old pt? and meds: Plavix 300mg x2, Heparin 5000 units, Lidocaine 50 mg, Nitroglycerin 0.4 mg X3, Nitroglycerin paste, Fentonyl 200mg x@, Ativon 2mg ampule, TNK 10MG, Then can I also do the needle and ekg pads seperate?

SuperCoder Answered Fri 28th of December, 2012 19:13:46 PM

Please confirm whether this is professional billing and what the place of service is. Based on the inclusion of 99050, this appears to be physician billing at the office. But intraosseous infusion and critical care are more likely to be seen in the facility setting.

To get started, note that many payers, including Medicare, won’t reimburse for 99050.

Be sure to meet the strict time and other requirements for 99291. If you’re in the office setting and your practice bears the cost of the meds, you may report the appropriate HCPCS codes for infused meds. The needle and EKG pad supplies wouldn’t be reported separately by an office.

For the IO infusion, check out this article:
Surgery: Musculoskeletal System. CPT® Assistant. December 2009; Volume 19: Issue 12
Question: What code is used for an intraosseous infusion? Ann Waters, RHIT, CCS
Answer: Intraosseous infusion administration is not reported by any specific CPT code. Patients receiving intraosseous infusion are typically inpatients. Hence, the intraosseous infusion per se is performed by hospital nursing staff and not separately reported with any CPT code. The physician work of ordering of the infusion (rate/ dose/duration) is already included in the appropriate level of the physician's inpatient hospital E/M service.
Code 36680, Placement of needle for intraosseous infusion, describes a procedure in which a hollow needle is inserted through the skin and through the muscle tissue to puncture the bone marrow cavity, usually in the tibia or femur of a patient, whose vessels are otherwise inaccessible. The needle is used as a method of infusing fluids into the blood vessels in the bone marrow.

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