Joann Posted Tue 13th of November, 2012 20:49:02 PM
52 yr old female presented to the ER with a subarachnoid hemorrhage. She was intubated at 12:15 and given
Succinylcholine 100 mg at 12:12,
Ketamine 50 mg at 12:12,
Dipervan 50 mg at 12:12
Propofol drip at 12:35 and was dripping at time of d/c
Norcoronin 10 mg at 12:31
Foley cath insertion 12:45
Since more drugs were administered to maintain sedation after the intubation was done, would you be able to charge the IV injection/infusion charges because they were given later? And would the insertion of the foley be coded also? There is an edit when charged with the intubation which can be bypassed with modifier 59 but I am not sure if it would be appropriate in this scenario.
SuperCoder Answered Wed 14th of November, 2012 06:18:24 AM
We are working on this.
Joann Posted Wed 14th of November, 2012 14:52:20 PM
SuperCoder Answered Wed 21st of November, 2012 12:57:08 PM
The pro side is 99291-25 and 31500.
However, I think you are probably inquiring about how to code the facility side for the multiple infusions and injections….though you didn’t really specify.
Please clarify regarding this so we can give a targeted answer…if pro side go with the above…if facility relating to meds just let us know and we’ll work out the answer.
Joann Posted Mon 26th of November, 2012 21:17:56 PM
This is for the facility side. I know injections are not charged during the procedure but not sure if it is to maintain "sedation" until patient can be transferred. And with the foley I am thinking that since the patient is sedated with no other reason for the foley to be placed then it would be included in the intubation charge. Thank you so much for your help!
SuperCoder Answered Thu 29th of November, 2012 14:48:53 PM
It would be appropriate to report any drugs administered outside of the duration of the intubation procedure. Without knowing specific stop times for the propofol drip or norcoronin, the following would be the suggested coding: 96365 (propfol drip) & 96375 (norcoronin). I assumed that the drip was running for, at minimum, 16 minutes which would support CPT 96365 and that the norcoronin was given IVP, supporting 96375. If the popofol drip was running less than 16 minutes, we would report 96374 (propofol) & 96375 (norcoronin).
The three drugs administered at 12:12 would not be reported separately as they would be included in the intubation procedure.
The insertion of foley cath (51702) can be reported in this scenario as well. There is a CCI relationship between the intubation (31500) and the foley; however, a modifier 59 is allowed on 51702. CCI would not allow the unbundling of CPT 51702 from 31500 if it was not appropriate to report the two codes together.