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Primary Care Coding Alert

Complete Your Superbill With Hydration G Codes, Inhalation J Codes

Published on Thu Jan 27, 2005

Avoid Medicare B-12 admin injection denials with G0351

If you don't use new codes for infusion, injections, nebulizer medication and respiratory syncytial virus tests, you could find yourself dealing with a pile of Medicare rejections this spring.

Bill Medicare Hydration With G0345-G0346

CMS introduces four HCPCS codes that temporarily replace infusion and injection codes 90780-90782. CPT 2006 will publish permanent codes for these services. Until then, Medicare requires the appropriate G codes.
 
Old method: CPT lumps hydration therapy with other non-chemotherapeutic infusion under 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour).

New method: You can specifically code intravenous (IV) infusion to hydrate a patient with G0345, and when appropriate G0346. Choose the code based on the IV infusion's length:
 

  • up to one hour - G0345 (Intravenous infusion, hydration; initial, up to one hour)
     
  • each additional hour after the first - G0346 (Each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]).

    Change Carrier 90782 Coding to G0351

    You should also use a G code when a Medicare patient receives a therapeutic, prophylactic or diagnostic injection.
     
    2004 method: Code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) previously described these types of injections.
     
    2005 method: You should now report the injection with G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa.


    You should replace 90782 with G0351 when the provider administers: 

  • a B-12 injection (also use J3420 for the B-12 itself)
      
  • a restorative treatment, like Decadron for croup.
     
    Payment alert: You should report G0345-G0346 and G0351 to Medicare carriers only. Medicare created these codes to comply with the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), Falbo says. Although the AMA formed a CPT Editorial Panel that revamped the codes, the panel did not complete the changes in time for CPT 2005.
     
    CMS, however, incorporated the changes this year. "New CPT codes will exist in 2006 for all to use, but right now practices are to use the G codes for Medicare only,"  Falbo says.
     
    Use Dose-Specific Nebulizer Medicine J Codes

    While you're updating your infusion codes, make sure to add four new nebulizer medication codes. HCPCS 2005 deletes the codes you previously used to report nebulizer medications: J7618-J7619.
     
    New way: You should now assign:

  • J7611 - Albuterol, inhalation solution, administered through DME, concentrated form, 1 mg
     
  • J7612 - Levalbuterol, inhalation solution, administered through DME, concentrated form, 0.5 mg
     
  • J7613 - Albuterol, inhalation solution, administered through DME, unit dose, 1 mg
     
  • J7614 - Levalbuterol, inhalation solution, administered through DME, unit dose, 0.5 mg.

    Benefit: "The new codes make reporting nebulizer medications easier," says P. Lynn Sallings, CPC, compliance officer for Family Medical Center, Area Health Education Center-Northwest in Fayetteville, Ark. You no longer have to lump Albuterol and Levalbuterol together as:
     

  • J7618 - Albuterol, all formulations including separated isomers, inhalation solution administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol)
     
  • or J7619 - Albuterol, all formulations including separated isomers, inhalation solution administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol).

     "Using the same codes proved confusing because the doses for each medication are different," Sallings says.
     
    Better way: When coding nebulizer medication, you can now locate the right code in two steps:
     
    1. identify the medication name: albuterol (Ventolin, Proventil) (J7611, J7613) levalbuterol (Xopenex) (J7612, J7614).
     
    2. locate the form:  concentrated (J7611-J7612) premixed or unit-dose (J7613-J7614).

    Report Specific RSV Lab Code

    In other news, CPT 2005 creates a laboratory code for in-office RSV testing.

    Old method: You previously had to report the test with an unspecified code: 87899-QW (Infectious agent detection by immunoassay with direct optical observation; not otherwise specified; CLIA-waived test). But you now have a specific code that describes the procedure.
     
    New method: You should use 87807-QW (Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus) for RSV Binex NOW and for Integrated Biotechnology's RSV test called Integrated Biotechnology Quick Lab.
     
    Editor's note: The February 2005 Family Practice Coding Alert reader question "Report Related Medicine, Not Equipment" and e-mail requested CLIA-waived chart did not include these new codes.

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