ED Coding and Reimbursement Alert

Medicare has its own codes for infusion sessions When the physician performs an injection in the emergency department, do you know the codes for intramuscular and intra-arterial shots? How about the difference between an infusion and an injection? Needles Make for Prickly Coding Areas Most emergency departments perform injections and infusions regularly, and there's a bit of a trick to reporting each type of service -- not to mention the challenge of keeping the procedures straight in your head on an especially hectic day.

Read on to learn the ins and outs of coding injections and infusions in facilities -- and how to report right on the first shot, so resources don't slowly drip from your emergency department.

Know the Injection Type ED coders should become familiar with different types of injections, because which code you choose will depend on the method the physician used to deliver the medication/blood product.

"Injections can account for a huge amount of money within the emergency department," says Karen Marsh, president of Kare-Med Consulting in Jensen Beach, Fla. Or they can account for huge headaches if you don't report them properly.

ED staff should know these injection codes, according to Caral Edelberg, CPC, CCS-P, president of Medical Management Resources in Jacksonville, Fla.:

90782 - Therapeutic, prophylactic or diagnostic    injection (specify material injected); subcutaneous or   intramuscular
90783 - ... intra-arterial
90784 - ... intravenous
90788 - Intramuscular injection of antibiotic (specify). Nurses or physicians perform injections, in which they deliver medications or blood products to the patient. Make sure you check the documentation to be certain you are coding for the right injection type; 90782 is not the right choice for all types of injections, Edelberg says.

The claim should prove that the proper type of injection code - subcutaneous or intramuscular,  intra-arterial, intravenous or intramuscular - was used to represent the injection on the claim.

"Each code represents [a single] injection," Edelberg says. "One unit of each code may be billed each time there is a separate injection that meets the definition of the CPT code."

Example: A patient reports to the ED with a severe migraine headache, and the nurse gives him a shot of Demerol. Report 90782 for the shot, because injections for migraine headaches meet the criteria for 90782. Other examples of shots coded with 90782 are injections of anti-nausea drugs or vitamin B-12. Watch for Exceptions Exceptions: Do not use 90782 for allergy shots, vaccine administration, trigger point injections or arthro-centesis/joint injections. They have their own code groups in CPT.

Hot tip: Locate a copy of Addendum B, Final Rule for the 2004 outpatient prospective payment system (OPPS) payment amounts for separately paid drugs, Edelberg says.

"The addendum tells you what drugs over $50 can [...]