Gastroenterology Coding Alert

Question: Our gastrointestinal nurses are billing for office injections at level one. Is this appropriate if we have the patients bring in their medications?

Arizona Subscriber

Answer: Billing for injections given by a nurse can be tricky. Nurses can bill for injections when the patients bring in their medications. Deciding whether to report the E/M code or the injection code is the hard part. The CPT descriptor for 99211 (Established patient office visit ...) does not require the presence of the usual three components (history, examination and medical decision-making). Usually the presenting problems are minimal, and the assistant typically spends about 5 minutes with the patient. You should never report 99211 with the injection code unless there were separate, identifiable services performed in addition to the injection. If the patient comes in solely for the purpose of receiving the shot and the nurse only asks the patient how he is doing, you should not report 99211. If, on the other hand, the nurse observes the patient for a reaction or takes vitals, you could bill for a separate office visit with 99211. This code is under scrutiny from many carriers, so you need to have documentation in order that indicates why the visit is significant and separate, either with a different diagnosis code or by describing the office visit thoroughly.

But when the patient brings in his own medications, you cannot bill for the supply of the drug, only for the administration. For example, a hepatitis patient brings in a supply of interferon for injection by the nurse. The nurse performs limited E/M services, including taking vitals and counseling the patient. You would code 99211-25 for the E/M and 90782 (Therapeutic, prophylactic or diagnostic injection) for the administration of the drug. Do not code for the supply.