ED Coding and Reimbursement Alert

Question: When the physician performs an intramuscular injection, are there any situations in which I could report 90782 for the injection and also a separate evaluation and management service?

Arizona Subscriber Answer: Medicare will pay for 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) if your physician performed no other service payable under the Physician Fee Schedule during that patient encounter.

If the physician provided additional services, such as an evaluation for wheezing, Medicare will consider 90782 bundled into the appropriate E/M code from the 99281-99285 code set (Emergency department visit for the evaluation and management of a patient, which requires these three key components ...).

Exception: On the other hand, private payers may reimburse 90782 and an E/M code when there is a compelling reason and significant medical necessity for the physician to be intimately involved with the injection and it has supporting documentation.