Outpatient Facility Coding Alert

Question: Our GI group owns its own endoscopic suite where colonoscopies are performed in this suite we bill POS as Office. Sometimes the patient is given Zofran through the IV used for the anesthesia. Our physicians do not bill for the anesthesia. We have an anesthesiology group that comes in and bills for the entire anesthesia done at our endoscopy suite. Since we don’t bill for this would it then be appropriate to bill for the 96374 with a 59 modifier and the J code for the Zofran?

Hawaii Subscriber

Answer:  As a norm, you should not report push IV medications separately if it is just another standard aspect of the sedation or anesthesia cocktail, since your anesthesia group will bill out separately for the anesthesia.  You can bill out the Zofran IV using 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug) when it is used to treat symptoms that occasionally occur after endoscopic procedures. It is best to append the modifier 59 (Distinct procedural service) to inform the payer that it is separate from the anesthesia that is being billed out separately by the other group.

For most office procedures, payers will view the supplies as part of the procedure. Some payers will pay while many will not, you should check with your payers. As a “non-routine supply” of a pharmaceutical, Zofran could be paid (again depending on Payer’s policy) with J2405 (Injection, ondansetron hydrochloride, per 1 mg) for every 1 mg of the Zofran that has been administered.