Internal Medicine Coding Alert
Correct Coding for Epinepherine Injection
Question: An established patient of ours came in the office following a bee sting, to which he has an allergy. The patient was evaluated by the doctor and given an injection of epinepherine, subcutaneous 0.5 cc. What is the proper procedure code for the epinepherine injection, a J code or a code in the 95115-95199 (allergen immunotherapy) range?
Mindy Bennett, Insurance Coordinator
Stephen M Smith, MD, Buckhannon, WV
Answer: The 95115-99199 codes are not appropriate because the shot was given as treatment, not as immunotherapy. CPT defines immunotherapy (desensitization, hyposensitization) as the parenteral administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale to a dosage which is maintained as maintenance therapy.
The correct code would be code J0170 for the injection, says Garnet Dunston, CPC, MPC, the national secretary of the American Academy of Procedural Coders. You should use code J0170 up to one milliliter. If it was over one milliliter, it would be this code times two.
You can also bill 90782 for the subcutaneous or intramuscular administration of an injection, but, according to Medicare guidelines, only the code for the drug (J0170) would be paid, she explains.
Giving the shot, according to Medicare guidelines, is included in the office visit. The medication should be billed using the J code.
Internal Medicine Coding Alert
- Use the Prolonged Services Codes Instead of -21 Modifier to Boost Reimbursement
As primary care providers, internists must often spend more time on patient care than might [...] - Use Correct Coding to Maximize Reimbursement for Pap-Smear Collection
Many practices erroneously bill laboratory codes instead of correct E/M codes
Coding [...] - Be Prepared to Track New CCI "Secret Codes" and Ward Off Payment Denials
Internal medicine practices may find themselves on the receiving end of some unexpected claim denials [...] - Carrier Telephone Review Lines Speed Appeals and Payments
Appealing denied or downcoded claims is one of an internal medicine practices biggest headaches. When [...] - Reader Questions:
Correct Coding for Epinepherine Injection
Question: An established patient of ours came in the office following a bee sting, to [...]
