Ob-Gyn Coding Alert

Question: I am looking for a CPT code for a packaged procedure for an ectopic pregnancy treatment. The physician is treating the patient in the office with methotrexate intramuscular to dissolve the ectopic growth. Is there a procedure code that includes the office visit and the injection all in one?

Cheryl Kuehne, CPC
Multicare Associates, Blaine, Minn.

Answer: There is a general rule with most third-party carriers that if a therapeutic injection is given at the time of a visit, the administration (90782, therapeutic or diagnostic injection; subcutaneous or intramuscular) of the medication is bundled into the visit code. In this scenario, the provider would bill for the evaluation and management (E/M) visit (99201-99215) and the HCPCS code for the medication (J9260, methotrexate sodium, 50 mg). Note that the drug methotrexate is a chemotherapeutic agent, and as such, some payers may allow the physician to bill 96400 (chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia) without a cancer diagnosis and in addition to the E/M service.

If the patient is receiving just the injection and there is not a separately identifiable E/M service rendered and documented, then the administration code 90782 (or 96400 when allowed) is billed in addition to the HCPCS code for the medication. Codes 59850-59857 (induced abortion, by one or more intra-amniotic injections), which include the admission and visits, are not accurate for the service you describe.

The above questions were answered by Emily Hill, PA-C, president of Hill & Associates, a coding and compliance consulting firm based in Wilmington, N.C.