Bill Injections/Infusions as Ancillary Services for Reimbursement

We dont code injections because theyre drugs the pharmacy takes care of that. Carol Dodd, RHIT, representative for MedQuists Division of Coding and Information Services, a coding, consulting and transcription company in Gibbsboro, N.J., hears this all too often from too many facilities facilities that are losing reimbursement theyre entitled to.

If you look in the Federal Register (interim and final rules from April and November) all of these injection codes are listed as status indicators X, which means they are an ancillary service payable under the 359 APC, Dodd says. CPT includes several codes for therapeutic, prophylactic or diagnostic injections: 90782-90784, 90788 (intramuscular injection of antibiotic) and 90799 (unlisted therapeutic, prophylactic or diagnostic injection). Despite the plethora of applicable codes, facilities just are not billing for injections. Dodd believes many are confused about the coding differences between the drug product and injection procedure.

Providing and Administering: Know the Difference

Dodd explains the difference. The pharmacy enters a drug code, which is generally paid through a different system or paid on the pass through. What were suggesting is that you are entitled to bill the drug administration code. If facilities arent coding for these injections in their outpatient setting, theyre losing about $48 per injection and I dont think anyone can afford to do that. Denial isnt the issue either; Dodd says her company hasnt seen any for these codes. Understanding the drug/administration difference and coding accordingly, particularly in the emergency department, should get the reimbursement your facility is entitled to.

Note: For more information on the pass-through list for drugs, devices and biologicals, see the February 2001 APC Alert.

Injections ranging anywhere from pain medications to cardiac drugs should all be coded under 90782 with a multiplier, if it applies, Dodd says. She explains that facilities are paid for the qualified personnel who pick up the order, get the medication, make sure the dosage is correct, administer the drug, and sometimes monitor the patient afterward. Reimbursement for this process is approximately $50, and there are many ED cases that involve multiple IM injections, she says. Coding for antibiotics is also an intramuscular injection (IM), but it falls under 90788. This code maps to the same APC as 90782 (359); however, it is good coding to apply it correctly. Facilities should use this code to identify antibiotics given in IM situations, Dodd says.

Note: Code multiple injections with a multiplier. For example, an IM injection would be coded times 3 or an IM antibiotic times 1.

Know When to Use IV Injection Code 90784

Code 90784 is for an actual intravenous (IV) medication, Dodd says. Patients often receive medications through an IV heplock, but placing an IV access doesnt [...]

- Published on 2001-03-01