Ob-Gyn Coding Alert

Hint: Look to modifier 25, not 59, to bypass E/M and injection edits

When your ob-gyn provides hydration or injection services, you should count that as part of the surgical procedure. The National Correct Coding Initiative (NCCI) version 12.0 strikes at the following new hydration and injection codes:

- C8950 -- Intravenous infusion for therapy/diagnosis; up to 1 hour

- C8951 -- -each additional hour

- 90760 -- Intravenous infusion, hydration; initial, up to 1 hour 

- +90761 -- -each additional hour, up to 8 hours (list separately in addition to code for primary procedure)

- 90772 -- Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 

- 90774 -- ... intravenous push, single or initial substance/drug

- +90775 -- -each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure).

In a nutshell: These new hydration and injection codes have been added to all surgical procedures. That means you shouldn't report the hydration, IV push or diagnostic injection separately from the surgery -- unless your documentation meets the criteria for supporting the use of a modifier (such as 59, Distinct procedural service).

Red flag: -With the addition of the new and renumbered injection codes, coders need to be aware that all of the E/M service levels have been bundled into each of them (such as, 90760-90775),- Witt says. This means that if you did not use an -approved- modifier to bypass the edit and bill both, payers would reimburse only the injection code, not the E/M service.

Keep in mind: You can use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to bypass an NCCI edit anytime your ob-gyn performs a procedure as well as an E/M visit -- but this modifier goes only on the E/M code, Witt says. -This is why when NCCI bundled 99205 into 90772 and gave this edit a modifier indicator of 1, you can use modifier 25 on 99205 to bypass this edit.-

Medicare has indicated that although a physician may be able to make a case for billing the intramuscular injection code with a higher-level E/M service (it would have to be separate and significant from the injection), you should never bill both when the E/M level is only 99211. For this reason, the bundling indicator assigned to 99211 is -0.-