Medicare Replacement w/injection administration

lisa dixon

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Gainesville, GA
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I have a claim where the patient brought in her zostervac from her pharmacy and we gave her the injection. We billed out the administration code and now her medicare replacement is denying the administration fee and tells me that we have to eat this charge. Has anyone else ran into this?

Thanks,
Lisa D
 

belindapearl

Networker
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48
Location
POPLAR BLUFF, MO
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Yes, Medicare will not pay for the adminstration 90772 without a J code attached. Since you did not provide the medicine you can not bill the j code. We bill 99211, this covers the cost
 

maysons1703

Networker
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Temple
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So does that mean that you do not code the 90772 for the administration only a E&M level? If u code 90772 with 99211 w/o modifier on the E&M level it will give you an NCCI edit. So are you using another ICD-9 code to justify medical necessity for the E&M?
 

maysons1703

Networker
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79
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Temple
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I agree with the ABN, the patient is responsible for the cost for this type of visit, because a 99211 is not appropriate when patient presents for injection only.
 

belindapearl

Networker
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48
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POPLAR BLUFF, MO
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No we do not bill for the 90772 at all. The patient is just there to see the nurse to recieve their injection of medicine that the patient supplied. Would this not qualify for a 99211 visit?
 

LLovett

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G0377 was deleted 1/1/08.

I have not had this issue with medicare but we do have the situation with medicaid a lot. The state is giving us the vaccines and we administer them. They will pay for the injection fee but we have to bill the J codes with $0 charges to show what we gave.

Laura, CPC
 

Lisa Bledsoe

True Blue
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Greeley, Colorado
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G0377 was deleted 1/1/08.

I have not had this issue with medicare but we do have the situation with medicaid a lot. The state is giving us the vaccines and we administer them. They will pay for the injection fee but we have to bill the J codes with $0 charges to show what we gave.

Laura, CPC
G0377 is not deleted in my copy of the 2008 HCPCS book. It is my understanding that Medicare simply stopped paying for this code 1/1/08...
 
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