Pediatric Coding Alert

Overlooking Synagis treatment change will delay $21 per claim.

You can save countless hours in appeals work this spring if you take three steps to get your injection and intravenous codes in line.

For 2009, the AMA relocates the "Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions" medicine subsection and renumbers the codes. "The descriptors didn't change at all," notes Jill M. Young, CPC, CPC-ED, CPC-IM, with Young Medical Consulting LLC in East Lansing, Mich.

The AMA moved the codes from after the "Vaccines, Toxoids" subsection to in front of the "Chemotherapy" subsection and combined both subsections' guidelines. "In order to assist users in more convenient comparison and use of the infusion services procedures, codes 90760-90779 have been deleted and renumbered for proximity to the chemotherapy and other complex infusion services reported with codes 96401-96549," states CPT Changes 2009: An Insider's View.

There were no changes in the hierarchy, Young says. "CPT 2009 just put the codes in a more logical place." Here's where you can find them now.

The next time staff administers a Decadron (J1100, Injection, dexamethasone sodium phosphate, 1 mg), Rocephin (J0696, Injection, ceftriaxone sodium, per 250 mg), or Synagis (90378, Respiratory syncytial virus immune globulin [RSV-IgIM], for intramuscular use, 50 mg, each) shot to a patient, double check that you're submitting 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Reporting the injection administration with the 2008 version 90772 will trigger an invalid code rejection delaying approximately $21 in pay. (Figure based on the 2009 Medicare Physician Fee Schedule assigning 0.58 transitional non-facility total relative value units [RVUs] to 96372 and using a conversion factor of 36.0666.)

Error averted: With how much time staff may spend taking the patient's vitals and checking any issues before giving an infant the second or third Synagis injection, you might be tempted to add 99211, which pays approximately $19 (0.52 RVUs) to the claim. But you shouldn't bill 99211 for the physician supervising this work.

The AMA considers the pre-administration work (whether it is IVIG, chemotherapy, or other drug administrations) part of the drug administration service, explains Cindy C. Parman, CPC, CPC-H, RCC, principal at Coding Strategies Inc. in Atlanta. Therefore, you should not separately bill the pre-administration work with a patient visit code.

For payers that adopt Medicare edits, 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) always bundles into drug administration codes performed on the same day, Parman notes. The Correct Coding Initiative does not allow a modifier to bypass these bundling edits.

The relocated subsection starts off with hydration. If your office provides rehydration therapy, make sure you change the codes on your office ticket and system to:

You'll be stuck with the IVIG procedure bill in 2009 unless you switch from 90765 and +90766 to new codes 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) (1.91 RVUs or approximately $89) and +96366 (... each additional hour [List separately in addition to code for primary procedure]); (0.61 RVUs or approximately $22).