Pediatric Coding Alert

Answer: Pediatricians use Synagis as a prophylactic treatment to prevent respiratory syncytial virus (RSV) for pediatric patients at high-risk for RSV. Because Synagis is an immune globulin (Ig), not an immunization, you should use 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for administering the injection, according to CPT's medicine guidelines. Remember that 90782 does not include the cost of the Ig vaccine, which you should report with 90378 (Respiratory syncytial virus immune globulin [RSV-IgIM], for intramuscular use, 50 mg, each).

In addition, prior to administering the injection, the nurse usually weighs the infant, takes his or her blood pressure and temperature, and records other vital statistics. If the nurse performs and documents these services, you should report CPT 99211 (Office or other outpatient visit for the E/M of an established patient typically 5 minutes are spent performing or supervising these services). To identify the E/M as a separate service from the injection administration, some payers may require modifier -25 (Significant, separately identifiable E/M by the same physician on the same day of the procedure or other service) appended to 99211.

Because pediatricians normally give Synagis to infants with a history of prematurity (less than 35 weeks of gestational age), you should use prematurity as the reason for 99211, 90378 and 90782. Link each code to the ICD-9 code that describes the baby's gestational period, such as 765.27 (Disorders relating to short gestation and low birthweight; weeks of gestation; 33-34 completed weeks of gestation).