Part B Insider (Multispecialty) Coding Alert

Published on Thu May 19, 2005 PDF

Prepare now for NCCI version 11.2

If you've been finding the new "G" codes for drug administration useful, then you may be in for a disappointment when the National Correct Coding Initiative version 11.2 takes effect in July.

Injection code G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) will become a component of 4,531 codes, and intravenous push codes G0353-G0354 each become components of 4,833 codes. Caveat: You will be able to override these edits by using a modifier, if you know the ropes.

Code G0363 (Irrigation of implanted venous access device for drug delivery systems [do not report G0363 if an injection or infusion is provided on the same day]) will become a component of 87 evaluation and management and worker's compensation codes, from 99201 to 99456. You won't be able to use a modifier to override those edits.

Initial intravenous infusion codes G0345 (Intravenous infusion, hydration; initial, up to one hour) and G0347 (Intravenous infusion for therapeutic/ diagnostic [specify substance or drug]; initial, up to one hour) each become components of 75 codes. The comprehensive codes include catheter insertion codes 51701-51703, brachytherapy codes 77761-77789, new tumor imaging codes 78811-78816, and several codes from the medicine section of the CPT book. You will be able to use a modifier to override those edits.

Injection is considered an inherent part of most procedures, notes Dawn Hopkins, senior manager for reimbursement with the Society for Interventional Radiology. Either CMS is seeing "widespread abuse" of the new injection G-codes by physicians trying to bill for them with many procedures, or this is a precaution. CMS may simply be trying to block all of the code combinations that haven't been commonly used so far, because they assume nobody ever bills them together, she notes.

In other edits: Duplex scan codes 93975-93979 will become components of IVC filter placement Codes 75940, but you will be able to use a modifier to override those edits.

Originally, CMS wanted to set those edits so you couldn't use a modifier with them, but SIR convinced the agency to allow a modifier, says Hopkins. "We were able to present to them that these were just unrelated procedures and they could be performed together," she explains. "You can't just base edits on the idea that I've never seen claims for A plus B, so A and B can never be performed together."