DAVID STERN, MD (Practice Velocity)
Q.I had a patient come in who needed IV fluids and monitoring for five hours. We found the CPT codes 96360 (intravenous infusion, hydration; initial 31 minutes to 1 hour) and 96361 (each additional hour…) to use for the IV hydration therapy. However, my doctor cannot believe how low these codes are reimbursed by his health insurance. We did bill an office visit in addition to the IV. Is this all we can bill?
– Nicole, Fresno, CA
A.I believe that you are using the correct codes. In addition to the correct codes, many physicians want to add codes for IV fluids, tubing, and a code for venipuncture. However, according to CPT, the following are bundled into (i.e., included in) the IV hydration codes:
- Use of local anesthesia
- IV start
- Access to indwelling IV, subcutaneous catheter, or port
- Flush at conclusion of infusion
- Standard tubing, syringes, and supplies
Don’t forget to list the 96361 multiple times, when appropriate. For this visit, for example, you might code an E/M code (e.g., 99203-25), 96360 (first hour IV hydration), and 96361 (each additional hour) x 4.
Q.Our urgent care clinic is trying to set up a contract, but the insurance company wants us to use the code S9083 (global fee urgent care centers). Is there a minimum or maximum amount we are allowed to charge? I have oked through several locations, and nothing is actually telling me the amounts. Can you please assist me?
– Pamela Seekford, Austin, TX
A.The contracted rate the payor will reimburse for this code should be noted in your contract with the payor; many times it is possible to negotiate a higher rate. There is no specific dollar amount that is standard for S9083. As you add payors, you should make sure your fee for S9083 is higher than the highest reimbursement level from any payor for the S9083.
Most software solutions will require you to manually enter the code. For efficiency and error prevention, you might want to look for software that is set up to automatically bill the S9083 (i.e., override other CPT and HCPCS codes) for specific payors that only pay on S9083.
Q.When a patient has chemical conjunctivitis and needs irrigation of the eye with a Morgan lens hooked up to a bag of fluids, how is this coded? What is the code for a Morgan lens?
– Maureen McRae, MD, Victor, NY
A.Some coders include the procedure in the E/M code. This is not intuitive; nor is it necessary, as the procedure adds significant expenses for supplies, staff time, additional risk, and facility usage. There is no specific code for Morgan lens irrigation. You might consider using the following codes:
Eye Irrigation Procedure (possible codes):
- 92499—Unlisted ophthalmological service or procedure;
- 65205—Removal of foreign body (external) from eye but non-surgical. (Note: 65205 is the code recommended by the It is not a perfect code, as the physician is usually trying to flush out a foreign liquid (which is not exactly a “foreign body.”);
- V2799—Vision service, miscellaneous.
- Morgan Lens: V2797—Vision supply, accessory, and/or service component of another HCPCS vision code.
- Fluid: J7120—Ringers lactate infusion, up to 1000 cc (code once per liter or part of liter used).
- IV Tubing: S1015—IV tubing extension set (not for Medicare).
It should be noted that, if you are coding for a hospital, many hospitals use Morgan lens irrigation as a criteria for a level 5 E/M code on the facility billing UB-04. If you are not billing on the UB-04, you should ignore this comment. Morgan lens irrigation does not affect the physician E/M that is billed on the CMS-1500.
Q.Our hospital has an off-site urgent care office that uses the same tax ID number as the affiliated hospital. We are having problems getting our facility fee reimbursed. We are currently filing the claim on a UB-04 with revenue code 456 and CPT 99202. Do you see any issues with this billing method? Should this be filed on a HCFA 1500 instead?
– Jessica Easterwood
A.If you performed separate contracting for the urgent care, you may have contracted as a physician office, in which case the payors will not reimburse on the UB-04. Many payors will reimburse hospitals (even for off-site urgent care centers) for the facility fee on the UB-04. You might find that the payor is expecting a different revenue code. Although some make more sense than others, possible revenue codes might include:
- 0456 Urgent Care
- 0516 Urgent Care Clinic
- 0519 Other Clinic
- 0520 Free-Standing Clinic n 0523 Family Practice Clinic n 0526 Urgent Care Clinic
- 0500 Outpatient Services.
I would recommend that you contact each payor to see what they expect. Don’t be surprised, however, if the rep you call is unable to help you, as many times the payor is not sure itself what codes are expected in the edits of their software.