Pediatric Coding Alert

Question: We've received notice from our payers that 90788 is invalid after Dec. 31, 2005. Is this correct? Which code(s) should we use to replace 90788?


Illinois Subscriber
Answer: Your payer is correct. CPT 2006 eliminated 90788 (Intramuscular injection of antibiotic [specify]) and 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).
 
As of Jan. 1, you have just one code to report all subcutaneous and intramuscular injections: 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

What this means for you: For all of your payers, you will now use 90772 for injections such as B-12 shots and therapeutic injections like intramuscular steroids. You will also report 90772 for antibiotic injections.

Potential pitfall: If you want to report an injection using 90772 when no supervising physician is present in the office suite, you will find it difficult. Under the descriptor for 90772, CPT instructs, "Do not report 90772 for injections given without direct physician supervision. To report, use 99211."

Direct supervision means that the physician must be present in the office suite and immediately available to furnish assistance and direction, according to most insurers' guidelines.

According to many payers' rules, however, you can't report 99211 (for an established patient nurse visit) without direct physician supervision either. This makes for a "Catch-22" situation.

Solution: Avoid getting stuck in this no-bill situation by ensuring you schedule patients for injections when the pediatrician is in the office. Remember to always separately report the product that you administer, preferably with an alpha-numeric HCPCS code.