No, those codes are for E&M services, not for injections. If the only service provided is an injection, then you should only be charging the injection code.Is it appropriate to charge a 99212 for a face to face provider injection and a room charge for a specialty clinic visit? I usually charge a 99211 for a nurse visit with an injection and nothing else, so this is a little different. It is our specialty clinic, not the RHC.
Thank you for the reply. I do know that the injection would normally be the only charge along with drug. However, we usually charge 2 codes for specialty clinic visits. One for the room, one for the E/M service. So we were thinking of charging out the room code at a 99211 level(our internal code), but there would not be the E/M charge for the service. For instance, a regular visit at the SC, no procedure, we charge the E/M level code for the service and the E/M level code for the room. Does that make sense? I think we ended up not charging for the specialty clinic room in this case as this rarely happens at the SC.No, those codes are for E&M services, not for injections. If the only service provided is an injection, then you should only be charging the injection code.
99211 and 99212 require documentation of an E&M service, and if performed on the same day as the injection, then the documentation would also need to support a service that is 'significant and separately identifiable' from the injection. A separate 'clinic visit' charge isn't justified unless your documentation meets these requirements.
There is no such thing in coding as a ‘room charge’, you can’t simply attach a charge for the patient being in the room - any charge has to be associated with a documented service. It sounds like you are talking about split billing here with a charge for the professional service and a ‘room charge’ representing the hospital’s facility charge corresponding to that same service - is that what you mean? If that’s the case, you’re correct that for the E/M service you can bill one charge for the provider and one for the hospital. But for an injection, there is only a hospital charge - there is no professional service portion for an injection - only the hospital can bill this. This is true whether the provider or the nurse performs the injection. So you can’t add on an E/M room charge on top of this, unless there was some kind of an E/M service also performed at that same encounter.Thank you for the reply. I do know that the injection would normally be the only charge along with drug. However, we usually charge 2 codes for specialty clinic visits. One for the room, one for the E/M service. So we were thinking of charging out the room code at a 99211 level(our internal code), but there would not be the E/M charge for the service. For instance, a regular visit at the SC, no procedure, we charge the E/M level code for the service and the E/M level code for the room. Does that make sense? I think we ended up not charging for the specialty clinic room in this case as this rarely happens at the SC.
Thank you for your reply.There is no such thing in coding as a ‘room charge’, you can’t simply attach a charge for the patient being in the room - any charge has to be associated with a documented service. It sounds like you are talking about split billing here with a charge for the professional service and a ‘room charge’ representing the hospital’s facility charge corresponding to that same service - is that what you mean? If that’s the case, you’re correct that for the E/M service you can bill one charge for the provider and one for the hospital. But for an injection, there is only a hospital charge - there is no professional service portion for an injection - only the hospital can bill this. This is true whether the provider or the nurse performs the injection. So you can’t add on an E/M room charge on top of this, unless there was some kind of an E/M service also performed at that same encounter.