Neurology & Pain Management Coding Alert

Payers won't allow separate payment for same-day injection

Recently, a Washington subscriber wrote, "It seems as if every time I report 90782 with an office visit on the same day, the payer denies the injection. What do I have to do to receive full payment for this combination?"
 
In fact, from the insurer's point of view, you're already receiving full payment, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. That's because you cannot report an office visit (99201-99215) and a therapeutic, prophylactic or diagnostic injection on the same day:
 
Payers consider 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) to be an "incidental" service and bundle it into any E/M code you report for the same visit. You may only report 90782 if the neurologist provides no other service during the same patient encounter.
 
"Do not pay ... 90782-90784 or 90788 if any other physician fee schedule service was rendered. ... If no E/M service or other service is provided on the same day as the injection, the injection code is billed," the Medicare Carriers Manual advises carriers.
 
You may, however, receive reimbursement for the drug supplies you use. In addition to the appropriate E/M code, you should also report the HCPCS J code for the injected drug.
 
For example, the neurologist meets with a patient complaining of ongoing headaches. She provides an E/M service and injects Toradol to provide some relief for the patient. In this case, report the E/M visit along with J1885 (Injection, ketorolac tromethamine, per 15 mg) to receive reimbursement for the drug supply.