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Therapeutic, prophylactic or diagnostic injection

  1. Smile Therapeutic, prophylactic or diagnostic injection
    Medical Coding Books
    Does anyone know for the year 2008 what is the appropriate code to use for the therapeutic, prophylactic or diagnostic injection that we use with J1080 or J3420? I am thinking of either 90472 or 90772, however, Medicare had say that we need to use 90471 instead. Does anyone have any thoughts on that? Do we also have to put a modifier-59 on it?

  2. #2
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    Quote Originally Posted by jouanlychen View Post
    Does anyone know for the year 2008 what is the appropriate code to use for the therapeutic, prophylactic or diagnostic injection that we use with J1080 or J3420? I am thinking of either 90472 or 90772, however, Medicare had say that we need to use 90471 instead. Does anyone have any thoughts on that? Do we also have to put a modifier-59 on it?
    Per CPT 2008:
    90772 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

    (For administration of vaccines/toxoids, see 90465-90466, 90471-90472)

    (Report 90772 for non-antineoplastic hormonal therapy injections)

    (Report 96401 for anti-neoplastic nonhormonal injection therapy)

    (Report 96402 for anti-neoplastic hormonal injection therapy)

    (Physicians do not report 90772 for injections given without direct physician supervision. To report, use 99211. Hospitals may report 90772 when the physician is not present)

    (90772 does not include injections for allergen immunotherapy. For allergen immunotherapy injections, see 95115-95117)


    FYI - 90472 aned 90474 are subsequent vaccine/toxoid administration codes (90472 is for IM, and 90474 is for oral or nasal admin.). You must bill an initial vaccine/toxoid administration code before you can bill 90472 or 90474, and the initial codes are 90471 (IM) and 90473 (oral/nasal).

  3. #3
    Default PS...
    No 59 modifier should be required on your admin code with the J-codes you have listed, but if you have any other codes from the surgery or medicine sections, you should check the guidelines to see if one is required. Also check guidelines regarding 25 modifier use on your E/M code, if you billed one.

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