Ob-Gyn Coding Alert

Question: When a patient comes in for injections of Depo-Provera or Lupron and the doctor sees the patient personally to talk to her (but does not give the injection), can I still bill 99211? Or, because the doctor was involved, should I report 99212? Also, what diagnosis code should I use for these injections? New Jersey Subscriber

Answer: You would not normally report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) if a doctor (or a nurse practitioner, certified nurse midwife, or physician assistant) sees the patient. As to what the physician can bill, this depends on what he documented. If the encounter is to counsel the patient, the physician can bill on the basis of time (he must document the number of minutes and the content of the counseling), and that will determine the E/M service level he may bill.

If the physician bills for an E/M service, however, he may not also code for the injection using 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) because it is included in the E/M service even if he did not personally give the injection. Note also that 99211 describes a minimal service, not an injection procedure. If the registered nurse or licensed practical nurse gives the injection and the physician or other qualified practitioner does not see the patient, you would report 99211 only if the nurse documented a minimal service in the record. That service will include more than the dose and name of drug injected. For instance, the note might include a blood pressure reading, a comment that indicates the nurse asked how the patient has been doing since her last injection, and an indication that the patient received the injection and had no reaction to the injection after observation. Diagnostic coding for the encounter (whether by the physician or the nurse) will be V25.49 (Surveillance of previously prescribed contraceptive methods; other specified contraceptive management). Answers to Test Yourself, You Be the Coder and Reader Questions were provided by Melanie Witt, RN, CPC, MA, an independent ob-gyn coding and documentation educator based in Fredericksburg, Va; and Brenda Dombkowksi, CPC, a coder with the Obstetrics-Gynecology and Infertility Group of Cheshire, Conn.