Getting the Best Reimbursements for Injection Medical Billing Claims

If an ED physician performs an injection, infusion or hydration on a patient, there is a way to secure maximum reimbursements for your medical billing claims by looking for additional claims for separate evaluation and management services on the op report to secure all of your deserved reimbursement on these claims, the reason is anytime there is a separately identifiable and significant E/M service is provided, you can charge for both the E/M and the injection/infusion/hydration codes.

The use of modifier 25 will make the claims payable with almost all carriers but there must be medical documentation to back it up to ensure reimbursement. .A good example of this would be if a 44-pound 5-year-old with vomiting and diarrhea presents with signs of moderate dehydration. The ED physician discusses with the parents the role of IV fluids rather than an attempt at oral rehydration. An IV is initiated, and a 400-ml bolus of normal saline is provided over one hour. The child’s condition then stabilizes.

During the hydration, the physician is immediately available for any issues and is in contact with and supervising the nursing staff. The physician reassesses the child after the hydration and initiates a trial of oral fluids. This would result in the following codings being used: 90760 (Intravenous infusion, hydration; initial, up to one hour) for the hydration, 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity). A modifier would be attached to the claim to show that it was significant and separate from the hydration.

View all Articles by: Melissa Clark, CCS-P