Otolaryngology Coding Alert

Question: We apply EMLA cream to numb the skin before giving immunotherapy injections. Insurers deny 99070 for the supply. Is there another code we should use?

New York Subscriber

Answer: CPT doesn't contain a code for eutectic mixture of local anesthetics (EMLA). For payers that deny CPT's generic supply code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), you may try HCPCS miscellaneous code A4649 (Surgical supply; miscellaneous). Make sure to submit an invoice with the claim form.
 
Some third-party payers don't cover topical anesthetic agents. In this case, you have no choice but to include the EMLA cream in the E/M service, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...), that the allergist provides prior to giving the penicillin injection (90788, Intramuscular injection of antibiotic [specify]).