Otolaryngology Coding Alert

Don't confuse 90782 with immunotherapy shots

Are you incorrectly assigning 90782 for injections, including allergy shots (95115-95199) and vaccine administration services (G0008-G0010 and 90471-90472)? Such a mistake could cost your practice $21 for each visit.

You should report 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) only for subcutaneous or intramuscular injections when the patient receives therapeutic, prophylactic or diagnostic services, not vaccine or toxoid injections, says Sheldrian LeFlore, CPC, senior consultant with Gates, Moore & Company in Atlanta.

CPT designates separate codes for immunotherapy and vaccine administration procedures. To code allergy shots, use the 95115-95199 series (allergen immunotherapy). When the physician administers a vaccine, choose G0008-G0010 (Medicare vaccine administration codes) for Medicare-covered vaccines, and 90471-90472 (CPT's immunization administration codes) for private payers.

Otherwise, if you submit 90782 for an immunotherapy or vaccine administration claim, your allergist will be out the $25 Medicare now pays for the code because Medicare will deny the claim.

If the allergist administers an antibiotic injection, you should choose 90788 (Intramuscular injection of antibiotic [specify]).

Example: You may use 90788 when the physician provides an intramuscular injection of penicillin to treat a patient's sinus infection, which is a complication of his allergic rhinitis (477.x). You should not report the other injection codes (90782-90784) when the physician injects an antibiotic because CPTspecifically designates 90788 for that purpose.

The 2004 fee schedule increased payment for 90788 by almost $18. If you report the code this year, you could expect $23, depending on your region.