Pediatric Coding Alert

Question: We apply EMLA cream to numb the skin before giving penicillin injections. Insurers deny CPT 99070 for the supply. Is there another code we should use?

New York Subscriber Answer: CPT doesn't contain a code for eutectic mixture of local anesthetics (EMLA). For payers that deny CPT's generic supply code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), you may try HCPCS miscellaneous code A4649 (Surgical supply; miscellaneous). Make sure to submit an invoice with the claim form.

Some third-party payers don't cover topical anesthetic agents. In this case, you have no choice but to include the EMLA cream in the E/M service, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...), that the pediatrician provides prior to administering the penicillin injection (90788, Intramuscular injection of antibiotic [specify]).
 
- Information for Reader Questions and You Be the Coder provided by Lisa M. Bride, a paralegal at Pediatric Management Consultants in Manhattan Beach, Calif.; Jeffrey Linzer Sr., MD, MICP, FAAP, American Academy of Pediatrics representative to the ICD-9-CM editorial advisory board; Teresa Thompson, CPC, CCC, a nationally recognized coding, compliance and reimbursement speaker and president of TM Consulting in Carlsburg, Wash.; and Richard H. Tuck, MD, FAAP, medical director of Quality Care Partners in Zanesville, Ohio.