# IM injection and IV push in the ER



## maudys

Can you bill for IM and IV infusions in the ER?  

Example - patient has DM and bronchitis, and receives Solu-Medrol IV, and insulin sub cut.  

I am receiving denials for these based on CCI edits, indicating that they cannot be billed together.

Any thoughts or advice appreciated.


----------



## ramirez505

*IM injection and an IVP*

You can bill for the IVP of solu-medrol, but the subq of insulin is a medication that can be self administered, so you are not supposed to charge for it.  Now if the insulin is being given IVP or drip infusion, you can charge for it. Hope that helps.


----------



## ahinman

You might also need a modifier on the facility E&M I know I get these as an edit and they can and should be billed together.  

Still if you have an IV push and an IM injection of somthing other than insulin or a vaccination you can still bill these two codes together.  They will still hit an edit and you will have to add a 59 modifier to one of them.


----------



## eadun2000

I realize this is late but it should have a 25 modifier on the e&m, 96374 if IV push or 96365 if infusion more than 15 minutes and a mod 59 on the 96372....... and YES you CAN bill for the 96372 in the er setting


----------



## ahinman

I am well aware that you can charge for an IM in the ER but NOT for inuslin IM.  If it is given IVP you can.


----------



## eadun2000

smflana said:


> I am well aware that you can charge for an IM in the ER but NOT for inuslin IM.  If it is given IVP you can.



I actually hate to tell you but you sure can.  I have been coding ER for over five years and I know for a fact that you can.  And another thing, insulin is not given IM.... it is given subcutaneous


----------



## ahinman

Would love to see your resources stating that you can do this?


----------



## lmbroomall

I have been coding er's for 10 yrs and YOU CAN NOT charge for the subcut insulin because it is a self-adminastraion drug. 
the e/m code needs a 25 added to it, charge the IVP and nothing for the IM isulin injection. 
If the insulin was given as an infusion then I would code for that.


----------



## Kristin

Per coding quidelines you need to as a -59 to any 96372 charged with a 96374 or a 96365.

As far as billing insulin given IM or SQ we currently do at our facility and we have never been directed no to per audits.


----------



## mitchellde

I too have always billed the sq insulin in the facility, I have looked thru numerous web sites and bulletins and I have seen nbothing that says this cannot be done.  So if those of you who are saying this is not allowed could provide your source document for that I would be very grateful.
Thank You


----------



## darcy.swan@vrh.org

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-Guidance/Guidance/Transmittals/downloads//R91BP.pdf * Look under C. Usually, pg. 4.  
Darcy Swan, CPC, CCS-P


----------



## mitchellde

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.*


----------



## ptrautner

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.... ??


----------



## liedym

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.


----------

