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ED Coding and Reimbursement Alert

Reader Question:

Consider How to Code Anaphylaxis Injection

Published on Mon May 18, 2020

Question: We saw a patient who came in after a yellow jacket sting. Initially she just had swelling and redness, but then during examination, she began to wheeze and her blood pressure dropped. She seemed to be weaving in and out of consciousness, and the physician determined she was in anaphylaxis. He administered 1 mg of dexamethasone acetate and 0.18 mg of epinephrine. He documented more than 30 minutes of critical care, and he and the nurse monitored her for three hours on and off. How should we code this?
Pennsylvania Subscriber

Answer: For this scenario, you should report 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) x 3 for the intramuscular dexamethasone acetate injection, the epinephrine injection, and the diphenhydramine hydrochloride injection.

In addition to 96372, you should also report J1094 (Injection, dexamethasone acetate, 1 mg) for the 1 mg of dexamethasone acetate that the physician injected and 18 units of J0171 (Injection, Adrenalin, epinephrine, 0.1 mg) for the epinephrine he administered. You’ll also report J1200 (Injection, diphenhydramine HCl, up to 50 mg) for the 25 mg of diphenhydramine hydrochloride.

The patient’s symptoms were initially life-threatening, and greater 30 minutes of critical care are documented. In this instance, you can choose to report 99291, (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and possibly also +99292 (... each additional 30 minutes (list separately in addition to code for primary service)), depending on the number of minutes documented.

Red flag: If your physician provides critical care services that do not total 30 minutes, CPT® advises you to report appropriate-level E/M codes instead.

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