Orthopedic Coding Alert

Question: When our nurses administer injections, we usually report the codes for injection administration, the drug and the nurse visit (99211). When our physicians administer injections, however, we don't report their E/M code with the injection code, so are we coding the nurses' injections incorrectly?

Colorado Subscriber

Answer: Most carriers maintain strict policies against billing for injectable medication administration (90782, Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular]) and a nurse's visit (99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...). You can bill either 99211 and the medication's J code, or 90782 and the medication.

In addition, you should only report an E/M service with an injection if you fulfill the requirements for appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Carriers would probably not consider the nurse's preinjection evaluation a "significant and separately identifiable E/M service."

Most practices adhere to the following rule when deciding which option to choose: If the nurse evaluates the patient at all (for instance, the nurse asks the patient to perform range-of-motion exercises before performing the injection), you should report 99211. If the nurse just administers the injection, you should report 90782.