Otolaryngology Coding Alert

Scoop: Medicare now pays for same-day injections and E/M services

You can help your allergist get paid for every injection service in 2005 if you learn which new G codes to report to Medicare in 2005 instead of 90782-90784 and how to report sequential push injections.

On Jan. 1, Medicare introduced temporary codes G0351-G0354 to represent therapeutic and sequential injections. These new codes replace CPT's 90782-90784, according to the Nov. 15, 2004, Federal Register. Ask your commercial carrier whether it will accept the G codes. Some private payers may still accept 90782-90784, but you should not report the codes to Medicare for any therapeutic injection service in 2005.  

Note: Medicare's new injection codes do not apply to allergen immunotherapy codes 95115-95199.

"However, CPT 90783 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intra-arterial) and 90788 (Intramuscular injection of antibiotic [specify]) remain in effect" for this year, says Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, manager of Deloitte & Touche's Healthcare & Life Sciences Regulatory in Boston.

For example, suppose the allergist or nurse administers an injection of epinephrine (J0170, Injection, adrenaline, epinephrine, up to 1-ml ampule) to a Medicare patient. You would list G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), not CPT's 90782 (...subcutaneous or intramuscular), which G0351 replaces. You should also report J0170 with G0351.

Note: Don't get too attached to these G codes. CPT will release new injection codes in 2006, which means Medicare will likely delete the G codes after 2005, coding experts says.

Get Your Reimbursement Update

Because the Medicare Modernization Act reduced the transitional payment adjustment to 3 percent in 2005, the new injection codes will offer less reimbursement than their CPT counterparts did last year. For example, G0351 pays $19, whereas 90782 paid $25 in 2004.

Even so, the new G codes are supposed to increase reimbursement, says Kristi White, CPC, a coding and reimbursement specialist in Illinois.

How? Prior to 2005, Medicare would pay for codes 90782-90788 only when the physician did not bill any other services on the same day, Siniscalchi says. But now you can report G0351-G0354 and 90783 and 90788 in addition to another payable service, such as an E/M visit.

Remember the 99211 Exception

"Evaluation and management codes other than 99211 may be separately paid when reported with a -25 modifier, but documentation will have to support an evaluation and management service over and above the injection and/or infusion," Siniscalchi says. You can't report 99211 in addition to the injection codes because Medicare includes 99211's relative value units (RVUs) with injection code payment.

Coding tip: You should report an additional E/M code only when the patient sees the physician, not when the patient presents to the nurse just for an injection, White says.

How it works: Your allergist bills for an intravenous push injection of Demerol (J2175) and a level-three established patient office visit. In this case, you would report G0353 (Intravenous push, single or initial substance/drug), drug code J2175 (Injection, meperidine HCl, per 100 mg) and 99213-25 (Office or other outpatient visit ... established patient ...; significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Be sure the documentation supports the physician billing a separate, distinct office visit.

When the physician bills an additional intravenous push of a non-chemotherapy drug, you should use new code G0354 (... each additional sequential intravenous push) in addition to G0353. Previously, CPT had no code to reflect sequential pushes.