Pediatric Coding Alert

Stop using 99070 as a catchall materials code

Boost your injection, repair, splint and inhaler claims anywhere from a dime to $25 with these hints on billing supply codes.

HCPCS level II codes are some of the most overlooked and misreported items. But insurers often reimburse these supplies.

Tip 1: Use the Specific HCPCS Code

You'll improve supply reimbursement if you stay away from the generic CPT code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). "Opt instead for a specific HCPCS code whenever one is available," says Paula Jacob, CPC, coding compliance manager at Medical Clinic of North Texas in Fort Worth.

Why? Insurance companies are more likely to pay for a HCPCS code because 99070 is so general. If you use 99070, you'll have to endure added paperwork, such as noting the item's description and attaching a copy of the invoice.

But you can usually avoid these steps. "Most insurers reimburse our supply charges with just the alphanumeric code," Jacob says.

Example: A nurse gives a 0.3-cc epinephrine shot to a child following a bee sting. You would code the drug with HCPCS code J0170 (Injection, adrenaline, epinephrine, up to 1-ml ampule). Using J0170 instead of 99070 more clearly identifies the medication and should speed the reimbursement ($4 based on Medicare national average payment).

Don't forget to report the E/M service with 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient) and the injection administration with 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).

Tip 2: Check if Service/Procedure Includes Supply

Although billing for medicine codes is fairly straightforward, reporting medical supplies can be more controversial. A code's "practice expense typically includes all equipment and supplies intrinsic to the code," says Julia M. Pillsbury, DO, FACOP, FAAP, a pediatrician at the Center for Pediatric Medicine in Dover, Del.

For instance, Pillsbury says, "a nebulizer treatment always uses the tubing (A4616, Tubing [oxygen], per foot]) and mask (A7015, Aerosol mask, used with DME nebulizer)," so 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) includes these supplies.

Another no charge: You always use a syringe, needle (OSHA-required needle-stick safety devices for this) (A4206-A4208, Syringe with needle ...), alcohol swab, and bandage (A6453, Self-adherent bandage ...) with a vaccine administration code. So, you shouldn't separately bill these supplies "to any carrier reimbursing on a relative value unit (RVU) basis," Pillsbury says.

Most pediatricians, however, have no way to know what supplies each code includes. "Also, not all payers follow the RBRVS payment system that assigns practice expense value reimbursements for the costs the CMS associates with a service or procedure," says Richard Tuck, MD, FAAP, a member of the American Academy of Pediatrics national committee on coding and nomenclature.

Best practice: You may separately bill for supplies. "But if a payer reimburses based on RBRVS policy, the insurer may include the charges in the procedure and deny separate reimbursement for the supplies," Tuck says.

How it works: You bill the tubing (A4616) and mask (A7015), but the insurer denies the A codes as part of 94640. That's what happens when Paula Jacob's group  reports the nebulizer-related supply codes. "Insurers aren't paying us for these," she says.

Tip 3: Let Hospitals Bill Their Supplies

If you code for a hospital-owned clinic or practice, let the facility handle the supply coding. "Because the practice has a contract with the hospital, the hospital bills for all drugs and supplies," says Andrea Topjian, BBA, RHIT, coding director at University Pediatricians in Detroit. The practice reports only the physician's services.