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Thread: IM injection and IV push in the ER

  1. #11


    AAPC: Back to School
    If you refer to CMS guidelines referring to billing of self injectable medications, you will see that any medication that a patient typically can inject themselves, you cannot charge the administration fee for a s/c insulin injection. See http://www.cms.gov/Regulations-and-G...ads//R91BP.pdf Look under C. Usually, pg. 4.
    Darcy Swan, CPC, CCS-P

  2. #12
    Join Date
    Apr 2007
    Columbia, MO


    This is intended to be geared to the physician office, emergency medicine is not the same, If the patient is unable to self administer the drug due to an emergent issue then the ER can administer the drug and be reimbursed for it. If you read carefully there is language that in a convoluted way does support this:
    K. Reasonable and Necessary
    Contractors will make the determination of reasonable and necessary with respect to the medical appropriateness of a drug to treat the patient’s condition. Contractors will continue to make the determination of whether the intravenous or injection form of a drug is appropriate as opposed to the oral form. Contractors will also continue to make the determination as to whether a physician’s office visit was reasonable and necessary. However, contractors should not make a determination of whether it was reasonable and necessary for the patient to choose to have his or her drug administered in the physician’s office or outpatient hospital setting. That is, while a physician’s office visit may not be reasonable and necessary in a specific situation, in such a case an injection service would be payable.

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
    Join Date
    Apr 2007
    Hartford, CT


    i know several faciliites are charging insulin sc and some are not , it is in the cms guidelines... my facility does not charge them but other places i have worked at have and never have they been denied.... ??
    Pat A. Trautner, CCS/CPC/CEDC/CHONC

  4. #14


    From my research it all depends on your MC carrier whether or not you can bill for injection of insulin. Some insurances will pay for administration of insulin when given subcutaneous. Bottom line..you need to check your local carrier and determine if you can or can not charge.

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