Otolaryngology Coding Alert

Question: Which code is used to report injection administration: 99211, 90782 or 90788? All the injections are given with physician approval after the patient has discussed his or her condition with the nurse.

Oklahoma Subscriber  
Answer: The administration of a prescheduled medication should be coded 90782 to 90788, depending on how deep the injection penetrated and the substance administered. Code 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) should be used if a basic, below-the-skin injection is administered or a non-antibiotic substance is injected into one of the muscles. Codes 90783 and 90784 describe intra-arterial and intravenous injections, and 90788 should be used only if an antibiotic is injected into muscle. Any other injection should be coded 90799 (unlisted therapeutic, prophylactic or diagnostic injection).
 
If the nurse discusses medications the patient is taking, gets the patient's weight and height and takes a pulse, and if there is a medical reason for doing so, E/M code 99211 (established patient visit, minimal problems) may also be billed with the injection code. If routine questions are asked, only 9078x should be used.
 
To bill the visit and the injection, modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or service) should be appended to 99211. Few carriers, however, pay for both. If 99211 is appropriate and can be justified, it should be billed instead of the injection code, because it has a value of 0.52 transitioned nonfacility RVUs, whereas 90782 (0.12 RVUs) and 90788 (0.13) pay less.