Pediatric Coding Alert

Use new code 90772 for Synagis and Rocephin shot

You can keep payment for therapeutic and antibiotic injection administration rolling in if you know these new fundamentals the procedures will require when the new coding method becomes effective Jan. 1.

Old way: In 2005, CPT contains separate injection administration codes for a therapeutic, prophylactic and diagnostic injection and an antibiotic injection. For instance, you had to report administration of a prophylactic Synagis treatment (90378, Respiratory syncytial virus immune globulin [RSV-IgIM], for intramuscular use, 50 mg, each) with 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) and a Rocephin (J0696, Injection, ceftriaxone sodium, per 250 mg) injection as 90788 (Intramuscular injection of antibiotic [specify]).

New way: CPT 2006’s introduction of one new injection code (90772, Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) ends the separate reporting that therapeutic injection services required and counts antibiotic injections as the same procedure. Code 90772 should make reporting injection administration easier because coders have only one code to use, says Diane Powell, office manager at Memorial Pediatrics in Bainbridge, Ga.

Memorize 90772 as Universal Administration Code

Although 90772’s descriptor doesn’t specify “antibiotic,” you should use the new code to report injection administration of an antibiotic. In a parenthetical instruction at the end of the “Therapeutic, Prophylactic, and Diagnostic Injections and Infusions” subcategory, CPT adds the directive “90788 has been deleted. To report, use 90772,” says Christine DuBois, CPC, president for 2005 of Pioneer Valley Coders. “Because CPT 2006 lumps therapeutic, prophylactic, diagnostic and antibiotic injections together, you no longer have to determine whether to classify a particular drug,” such as Rocephin, “as 90782 or 90788.”

Example: A pediatrician administers a Decadron injection for a child with croup. You would have previously had to identify Decadron ( J1100 , Injection, dexamethasone sodium phosphate, 1 mg) as a therapeutic treatment to realize you should code 90782 instead of 90788. Now, you’ll just have to remember to assign new code 90772. (For 90772 requirements when staff perform injection administration, see “Ask 3 Questions When Nonphysician Performs IM Injection” later in this issue.)

 Advanced coders should have been able to classify drugs as therapeutic or antibiotic. “But using two separate codes for basically the same procedure wasn’t really necessary,” DuBois says. The J code identifies what drug the nurse injects.

In fact, some payers already lumped antibiotic injection administration with the other injection administration routes. For instance: The Texas Medicaid manual stated you should use 90782 for all intramuscular injections.

Unfortunately, 90772 won’t eliminate keeping track of confusing insurer-specific bundles. “We billed deleted codes 90782 and 90788 only to private payers,” Powell says. Georgia Medicaid disallows reporting these services, which it includes in any payable physician fee schedule service that the physician provides at the same encounter. Powell expects the same bundle to apply to new code 90772.

Attach Modifier 25 to E/M Code

CPT also clarifies that you do need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when a pediatrician performs a significant, separately identifiable E/M service in addition to injection administration. Although some payers previously required the modifier on 99201-99215 (Office or other outpatient visit  …) with deleted codes 90782 and/or 90788, CPT 2005 did not contain this requirement.

The “Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy)” introductory notes now make that directive clear. “If a significant separately identifiable evaluation and management service is performed, the appropriate E/M service code should be reported using modifier 25 in addition to 90760-90779. For same-day E/M service, a different diagnosis is not required,” CPT 2006 states.

Tip: If you’re experiencing insurer E/M service-administration bundles, use modifier 25 on 2006 claims and “include CPT’s instructions in your appeal letter,” says Barry Hersey, administrator at Pediatric Care of York PC in Pennsylvania. “But if the edit is part of the insurance company’s policy, the instructions probably won’t affect payment.”