Pediatric Coding Alert

Question: A pediatrician admitted a patient to the hospital and ordered a penicillin injection for the patient that a nurse administered. In 2008, the Correct Coding Initiative (CCI) did not allow reporting 90772 with 99221-99223. In 2009, do private payers that follow the CMS editing system allow reporting CPT's new injection code in addition to the hospital care?

North Carolina Subscriber

Answer: No, the current version of CCI (version 15.0, effective Jan. 1, 2009) carries over the same edits that applied to 90772 and inpatient care codes to new injection code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

CPT 2009 brought renumbered infusion and injection codes (96360, 96365, 96372, 96374, and +96375), and CCI 15.0 responds by bundling these codes into all observation (99217-99220, 99234-99236), hospital (99221-99233, 99238-99239), inpatient consultation (99251-99255), emergency department (99281-99285), nursing facility care (99304-99337), home services (99341-99350), newborn care services (99460-99463), and inpatient neonatal intensive care services and pediatric and neonatal critical care services (99466, 99468-99480). Private payers that adopt CCI will include the same edits.

These are not new edits per se, because the old codes representing these services were bundled in previous CCI versions.-In a facility, the facility staff provides the infusion or injection. Therefore, the facility should receive payment for the procedure code's practice expense.