Coding help please!


True Blue
Overland Park, Kansas
Best answers
We are in need of some clarifacation on two issues at our office, please:

1. If a patient comes into the office for knee pain and gets an immunization vaccination while there, do you add -25 to the office visit code (E/M)?

2. If a patient comes in and gets multiple drug injections, do you use 90772 for each injection with -59 attached, or do you use 90772 once for x amount of the differant injections?

These questions are causing quite a debate in our office and we want to see how other sites are handiling this. Thanks.
Best answers
Injections, Immunizations etc.


Multiple injections
Q. I diagnosed a patient with bronchitis and gave him a Rocephin injection because of his other health issues. The patient also received a B-12 shot for pernicious anemia. Should I report the injection code 90772 more than once? And if so, should I use units or a modifier?
A. When a patient receives multiple injections, you should report each injection using 90772 (therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Code 90772's descriptor specifies "injection," not "injections" plural.
Whether you should use units or a modifier to report more than one therapeutic, prophylactic, or diagnostic injection depends on the payer. Some payers may require units, such as 90772 x 2. Others will prefer a modifier on the second injection code, probably –59 (distinct procedural service) to indicate the B-12 injection as occurring at a separate site from the Rocephin shot. Check with the insurer before sending in the claim.
You can help identify the injections as separate services rather than accidental duplicate billing by using different diagnoses. For example, link the Rocephin injection (90772) to a bronchitis ICD-9 code (such as 466.0, acute bronchitis). Report the B-12 injection (such as 90772–59) with its associated diagnosis, such as 281.0 (pernicious anemia).


E & M Services Provided on the Same Date

If a significant, separately identifiable Evaluation and Management service is performed on the same date as an immunization service, the appropriate E & M code should be reported in addition to the vaccine and toxoid administration codes. Report a -25 modifier with the E & M code to indicate that the service performed was significant and separately identifiable from the work of administering the immunization.