ED Coding and Reimbursement Alert

Question: When the physician sees the patient for an injury in the ED, is it appropriate to use 90782 for a tetanus toxoid administration?


Alabama Subscriber

Answer: Since the "incident-to" provision does not apply in the emergency department, and you would have a difficult time justifying the medical necessity of having the physician administer the injection, you will rarely report 90782 (Therapeutic, prophylactic, or diagnostic injection [specify material injected]; subcutaneous or intramuscular) in the ED setting.

In the office setting, CPT instructs you to select the name of the procedure or service that accurately identifies the service performed, rather than one that merely approximates the service the doctor provided. Because there is a more accurate code - 90703 (Tetanus toxoid absorbed, for intramuscular use) - you should report that with the administration code, 90782.

Hint: Do not append modifier 51 (Multiple procedures) to vaccine/toxoid product codes or to the administration codes. If the physician also performs a significant, separately identifiable evaluation and management service, you can report that in addition to the vaccine/toxoid and administration codes. Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.