Pediatric Coding Alert

Question: What CPT Code should I use for a Synagis injection when the patient's parent brings in the medication?

New Jersey Subscriber
 
Answer: Pediatricians administer Synagis as a prophylactic treatment to prevent respiratory syncytial virus (RSV) for pediatric patients at high-risk for RSV. Synagis is an immune globulin (Ig), not a vaccine. Therefore, you shouldn't use the vaccine administration codes for administering Synagis. You instead should report therapeutic injection code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).
 
Even though the infant's parent supplies the Ig, you may still use 90782. The injection code doesn't include the cost of the RSV-Ig. When you supply the Ig, make sure to report 90378 (Respiratory syncytial virus immune globulin [RSV-IgIM], for intramuscular use, 50 mg, each).
 
You also should report an E/M code, provided the nurse or pediatrician performs and documents taking clinical information. For instance, prior to administering the injection, a nurse weighs the infant, takes his or her blood pressure and temperature, and records other vital statistics. In this case, you should report 99211 (Office or other outpatient visit for the evaluation and management of an established patient ... typically 5 minutes are spent performing or supervising these services) for the nurse's services. To identify the E/M as a separate service from the injection administration, some payers may require you to append modifier -25 (Significant, separately identifiable evaluation and management by the same physician on the same day of the procedure or other service) to 99211. When your pediatrician performs and documents the E/M service, you should use 99212-99215.