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IV hydration with Zofran and Solu-Cortef

Sophie Posted Wed 03rd of April, 2013 16:41:41 PM

HELP! I'm driving myself crazy reading and re-reading the CPT book and past post on this issue...estab pt was seen for diarrhea with some nausea and vomitting. The physician decided to hydrate pt in the office for dehydration. THIS IS WERE I NEED HELP...

1050-SUCCESSFUL IV START RAC #22G LR 1000 ML STARTED
1105-BP -90/51, HR-60, RR-16. C/O NAUSEA 5 ON SCALE 1-10
1120-PHYSICIAN AWARE PT C/O NAUSEA - ODANSETRON 4 MG SLOW IVP GIVEN PER HIS ORDER. LOT#DM11733, EXP 6/30/2014
1140-BP 89/51, HR 62. RADIAL PULSE +2 SKIN COLOR IMPROVING
1150-PHYSICIAN IN TO SEE PT. ORDERED ADDITIONAL 500 ML LR & SOLU-CORTEF 100 MG ORDERED. WILL SEND CBC/DIFF LABS
1210-SOLU-CORTEF 100 MG SLOW IVP GIVEN. PT'S SON W/PATIENT.
1230-BP 93/52, HR - 61.
1240 - PT D/C TO HOME ACC BY HER SON AFTER SPEAKING WITH PHYSICIAN ABOUT PREDNISONE TO BE TAKEN NEXT FEW DAYS. REQUESTED PATIENT CALL IN THE A.M. TO UPDATE HOW SHE IS FEELING - SHE AGREES.

this is what i'm getting from what's listed above on how to bill:
1) 99214-25 w/ dx 787.91, 787.01, 276.51 (*e/m visit)
2) J7120 x2 w/ dx 276.51 (*1500ml Ringers Lactate)
3) 96360 w/ dx 276.51 (*1st hr hydration infusion)
4) 96361 w/ dx 276.51 (*addit 40min hydration infusion)
5) J2405 x4 w/ dx 787.02 (*Odansetron 4mg)
6) 96375 w/ dx 787.02 (addit IV push for Odansetron)
7) J1710 x2 w/ dx 787.02 (*Solu-Cortef 100mg)
8) 96375-59 w/ dx 787.02 (addit IV push for Solu-Cortef)

Is this correct?? If not please advise on the correct codes and the reason for the different codes from what i have selected above.
Thanks you soooo much!

SuperCoder Answered Fri 05th of April, 2013 09:47:49 AM

Infusion coding is very confusing and, frankly, there are a lot of gray areas when applying the codes and guidelines to real-world scenarios. In this case, you have a patient seen for diarrhea, nausea, vomiting, and dehydration. The patient receives therapy for the nausea and dehydration. The info listed doesn’t give stop times, which should definitely be documented, but based on the coding listed, it appears hydration ran for 1h 40 min. Then there’s an IVP of ondansetron for nausea and an IVP of Solu-Cortef (steroid).

With that in mind, reconsider the coding for the lines marked with ** below

99214-25 w/ dx 787.91, 787.01, 276.51 (e/m visit)

** 96374 w/ dx 787.02 (initial IV push, Ondansetron – the patient presented complaining of multiple issues, and therapy of nausea is considered to be higher in the hierarchy than therapy of dehydration; note that CPT says to use +96375 with several codes, but the initial hydration code 96360 isn’t listed, suggesting therapeutic IVP isn’t expected to be secondary to hydration)

J2405 x4 w/ dx 787.02 (Ondansetron 4mg)

** +96375 w/ dx 787.02 (addit IV push for Solu-Cortef, add-on as subsequent to 96374)

** J1720 x1, the HCPCS manual points to J1720 (100 mg per unit) rather than J1710 for Solu-Cortef, w/ dx 787.02 (Solu-Cortef 100mg)

** +96361x2, hydration, each additional hour; guidelines state +96361 is appropriate if performed secondary to 96374; dx 276.51 (1 hr 40 m hydration infusion)

J7120 x2 w/ dx 276.51 (1500ml Ringers Lactate)

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