Practice Management Alert

Question: A patient who had been stung by a bee came into our office and was exhibiting signs of anaphylaxis. Under the physician assistant’s direction, the nurse administered epinephrine. Our biller reported 99070 for the drug supply, 99213-25 for the PA’s E/M service, and 96372 for the injection. The insurance denied payment for the drug. Is that included in the administration coding?

Vermont Subscriber

Answer: The epinephrine supply is not included in the 96372 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) administration code or the 99213-25 (Office or other outpatient visit for the evaluation and management of an established patient … Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) E/M service.

The problem you are having is not that the payer is including the drug supply into another service you are billing. Instead the issue is the drug supply code you are using.

You’ll improve supply reimbursement if you stay away from the generic CPT^® code 99070 (Supplies and materials [except spectacles], provided by the physician or other qualified health care professional 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. In this case, you would use HCPCS code J0171 (Injection, adrenalin, epinephrine, 0.1 mg). Using J0171 instead of 99070 more clearly identifies the medication and should speed the reimbursement.

Why? Insurance companies are more likely to pay for a HCPCS code because 99070 is so general. If you use 99070, you’ll often 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 your supply charges with just the alphanumeric code.