Ob-Gyn Coding Alert

Question: I understand that 90782 includes an E/M visit. But what if the patient has a prescription for the injectable filled at a local pharmacy and brings it to our office to have it injected? We have patients come in with their Depo Provera for birth control who have purchased it through their drug program.

Virginia Subscriber

Answer: If the patient presents simply for an injection, the only correct code is 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular), along with a J code for the medication injected (for Depo Provera, for example, J1051, Injection, medroxyprogesterone acetate, 50 mg). In the above case, you should report only 90782 because the patient provides her own medication.

You might also be tempted to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...), but reserve this for a medically indicated E/M service that your practitioner provides at the time of the injection. And noting the injection reason, dose, and direction to return in two weeks is not a valid medically necessary E/M service. Payers bundle such service into the injection procedure.