Otolaryngology Coding Alert

Question: We-ve received notice from our payers that 90788 is invalid after Dec. 31, 2005. Is this correct? Which code(s) should we use to replace 90788?


Illinois Subscriber

Answer: Your payer is correct. CPT 2006 eliminated 90788 (Intramuscular injection of antibiotic [specify]) and 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).

Similarly, HCPCS 2006 no longer lists G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

As of Jan. 1, 2006, you-ll have just one code to report all subcutaneous and intramuscular injections to Medicare and your other payers: 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

What this means for you: For all of your payers, you will now use 90772 for injections such as B-12 shots and therapeutic injections like intramuscular steroids. You will also report 90772 for antibiotic injections.

Potential pitfall: If you want to report an injection using 90772 when there is no supervising physician present in the office suite, you will find yourself between a rock and a hard place. Under the descriptor for 90772, CPT instructs, -Do not report 90772 for injections given without direct physician supervision. To report, use 99211.-

Direct supervision means that -the physician must be present in the office suite and immediately available to furnish assistance and direction,- according to CMS guidelines.

According to Medicare, however, you can't report 99211 (for an established patient nurse visit) without direct physician supervision either. This makes for a -Catch-22- situation.

Solution: Avoid getting stuck in this no-bill situation by ensuring you schedule patients for injections when the physician is in the office.