Primary Care Coding Alert

Question: When a patient comes in for an office visit and is given an injection of Bicillin (90788), we use the diagnosis code for bronchitis. Does the office visit need a separate diagnosis code so the injection is not bundled with the E/M service?

Texas Subscriber
Answer: For a Medicare patient, bill for the office visit (99201-99215) and the J code for Bicillin (J0530-J0580). Use the diagnosis for bronchitis (e.g., 490, bronchitis, not specified as acute or chronic) for both the E/M code and the J code. Medicare includes the administration of the injection in the E/M code.
 
For a non-Medicare patient, bill the E/M code, the J code and 90788 (intramuscular injection of antibiotic [specify]) for the administration. Use the diagnosis of bronchitis on all three codes. Some payers require that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to the E/M code. Ask your carrier if this is necessary. 
Answers to You Be the Coder and Reader Questions provided by Barbara Cobuzzi, CPC, CPC-H, CHBME, president of Cash Flow Solutions, a physician reimbursement company in Lakewood, N.J.; and Debra Wiggs of Community Physicians Administrative Support Services (ComPASS) in Lynden, Wash.