# Physician billing for injections/supplies



## EK226 (Dec 7, 2009)

Hi everyone, 

I am reviewing a bill received by a physician who performed nerve block injections and is billing with 62311, 77003, 96374.   In addition to these codes the physician is also submitting a bill for several other codes which include 96360 (IV infusion, hyrdration) then a variety of different supply codes for ex: A4209 syringe w/ needles, A4520 Incontinence garment, A4216 Sterile water, A4930 gloves, A6219 Gauze.   And a third bill for a series of medications such as: J1040 methylprednisolone, J2001 lidocaine, J2795 Ropivaccine, J2250 midazolam, &
J2405 ondansteron.   

I was a bit overwhelmed when reviewing all of this information because it seemed to be that some of these charges were pretty basic and would appear to be included with the actual injection procedures (62311 & 96374).  

I did refer to the surgery guidelines in the CPT manual and I did see where it states under Materials Supplied by Physician that supplies and materials provided by the physician over and above those usually included with the procedure(s) rendered are reported separately.   So my question is how would I be able to determine what is considered over and above and what would be considered unbundling of charges that should be inlcuded in the price of the injection? 

Any suggestions would be greatly appreciated!
Thanks,


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## mitchellde (Dec 7, 2009)

Procedure note?


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## EK226 (Dec 8, 2009)

Hi Debra, 

Do you mean to refer to the progress notes?  I did look at the progress notes supplied by the physician and they are very vague. The progress notes appear to be in the form of a checklist, and the physician has checked off that an Epidural block was performed, Diprivan was given for conscious sedation, a sterile #20 gauge Crawford needle was inserted, and then injected 12mg DeproMedrol and Xylocaine 0.5%.  This is pretty much everything that is listed on the progress note. 

Nowhere on the form does it mention a full list of supplies that are being used.  I was thinking that in order for him to bill out all these extra supplies that it should be documented somewhere in the progress notes to explain everything that was done that day.  Or maybe I am overthinking this one?   

Thanks,


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## mitchellde (Dec 8, 2009)

I have several issues here, first is there is no procedure note and I would not code for a procedure without one.  Second I do not see where the IV push is.  If an epidural was performed then that is the 62311.   Since no conscious sedation is documented then there is not any to code.  No flouro documented then no code.  no you cannot code for supplies that are a necessary part of the procedure.  I would code nothing, however if pushed you might be able to make an weak argument for the 62311 but nothing else.  And I doubt it would stand up in an audit.  Sorry but that is what I see, ... no codes.


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## EK226 (Dec 8, 2009)

Hi Debra!

I do agree with what you are saying.  I do not feel comfortable at all with these notes, and cannot justify all of the procedures he is trying to bill for.  Thank you again for all of your helpful suggestions!


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