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To Bill or Not to Bill: an Infusion Case Study

Rheumatology Practice Management April 2018 Vol 6 No 2 - Coding Corner
Jean Acevedo, LHRM, CPC, CHC, CENTC, AAPC Fellow
President and Senior Consultant
Acevedo Consulting
Delray Beach, FL

 

 To Bill or Not to Bill: an Infusion Case Study

A National Organization of Rheumatology Managers (NORM) board member received this question from a member of the organization, “This is a query for anyone who is familiar with the billing and coding of infusions. The patient presents for infusion, and nurse obtains vitals on patient. An IV [intravenous] line is placed, and the nurse obtains a blood sample for complete blood count (CBC) via the IV. A 250-mg bag of saline is attached to the IV line and is set to KVO [keep vein open]. The CBC is performed, and the result is abnormal. The physician is consulted and a determination to cancel treatment occurs. The nurse removes the IV line, and the patient is bandaged and discharged. What, if anything, can be billed in this scenario?”

To answer this question, let’s review the case study to see what items or services may be billable. Based on the scenario described, the following services were provided—IV was inserted, blood was drawn via IV, 250 mg of saline was set up, CBC was performed, and IV was discontinued.

As you attempt to determine what—if anything—is billable, it is important to keep some specific requirements in mind, such as the fact that all diagnostic and therapeutic services require a physician/nonphysician practitioner order.

If we assume there was an order for the CBC, then I would say that this test is billable. After all, it was performed and the physician really did use the results in the patient’s treatment. The question would then be about what Current Procedural Terminology (CPT) code to use for the CBC. Because there is a code for a CBC (85027) and another for a CBC with differential (85025), to answer this question we would not only have to see which test was performed, but also which test was specified in the order.

No venipunctures (CPT code 36415) are billable, as the blood was drawn via the IV line.

Can the normal saline (Healthcare Common Procedure Coding System code J7050), which was hooked up to the IV line, be billed? No, it cannot, because nothing indicates that the saline was medically necessary.

What is implicitly documented is that the nurse consulted with the physician regarding the abnormal CBC, and the physician ordered that the IV be discontinued. If the nurse documented all of this in the patient’s chart (let’s assume she did), it appears she rendered a “nurse visit,” and should be able to bill for that with CPT code 99211. There was a “chief complaint” (the abnormal CBC), and, after consulting with the patient’s physician, the nurse followed the physician’s orders/instructions—all of which are requirements for billing a nurse visit.

In conclusion, based on the information provided and an assumption about an order for the blood test, it appears that the physician practice can bill CPT code 99211, and either code 85025 or code 85027, depending on the test that was ordered and the test that was actually performed.

Thank you to the inquiring NORM member for creating a case study that made us stop and think!

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Last modified: May 3, 2018
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