Ob-Gyn Coding Alert
90385 or J2790: Query Payer for RhoGAM® Claim
Question: A patient came into our ob-gyn office just for a RhoGAM® shot and not for her return OB visit. A nurse provided the injection. The initial claim had 90384 and 96372 with V07.2. The insurance company denied it, saying it is not routine. Our office billed the patient for her deductible. Shouldn't this be part of global care? Is the coding incorrect?
Georgia Subscriber
Answer: RhoGAM® is not part of a patient's global care. Most payers pay separately for this. You don't specify whether you applied the injection procedure or the drug itself to her deductible (or both). That is a coverage issue between the patient and her insurance company and should have nothing to do with when it was given (separate visit or at the time of the return OB visit). You billed this encounter correctly assuming the program accepts the CPT® code for the drug (90384, Rho[D] immune globulin [RhIg], human, full-dose, for intramuscular use) rather than J2790 (Injection, Rho[D] immune globulin, human, full dose, 300 mcg [1500 i.u]).
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