Oncology & Hematology Coding Alert

Question: Can I report 90782 for injection administration multiple times with multiple injections or only once?

New Jersey Subscriber

Answer: Medicare will pay for 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) if your oncologist performed no other payable service during that patient encounter. If the physician provides additional services, such as evaluation for neck tumors (195.0), Medicare will consider 90782 bundled into the appropriate E/M code (99211-99215).
 
On the other hand, private payers may reimburse when you bill 90782 and an E/M code. CPT and AMA guidelines state that you can appropriately bill 90782 with an office visit code, such as 99213 (Office or other outpatient visit ... established patient ...), when the physician administers the injection during a visit that involved more than one injection. Even so, private insurers vary on whether they pay for both 90782 and an E/M code, so check with your payer.
 
Some coders recommend that you report 90782 for each injection given. For example, suppose a nurse administers two separate injections of epoetin alpha (Q0136) and granisetron (J1626). You should report 90782 x 2.
 
Don't forget to report the appropriate J code for the medication that the physician injected. In the above example, you should report Q0136 and J1626.