Internal Medicine Coding Alert

Published on Sun Oct 26, 2003 PDF

Question: Can we submit both 90782 and CPT 99213 to a private payer? We know Medicare will not pay for 90782 and an E/M code but have heard that private insurers don't bundle the two.

Arkansas Subscriber

Answer: CPT and AMA guidelines state that you can appropriately bill 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) with an office visit code, such as 99213 (Office or other outpatient visit for the E/M of an established patient) when the physician administers the injection during that visit. Even so, private insurers vary on whether they pay for both 90782 and an E/M code, so ask your payer.
 
Also report the appropriate J code for the medication the physician injected. For instance, a patient presents for a B-12 shot, so you should report J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1,000 mg).