Primary Care Coding Alert

This tactic will pre-empt losing $21 for B12 shot.

If you-re not up on the latest do's and don-ts of injection procedure coding, you could be overcharging or throwing away almost $70 from a 2009 claim.

The next time staff administers a Decadron, vitamin B12, or Benadryl shot to a patient, double check that you-re submitting 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Reporting the injection administration with the 2008 code 90772 will trigger an invalid code rejection delaying approximately $21 in pay. (Figure based on the 2009 Medicare Physician Fee Schedule assigning 0.58 transitional non-facility total relative value units [RVUs] to 96372 and using a conversion factor of 36.0666.)

For 2009, the AMA relocates the "Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions" medicine subsection and renumbers the codes. "The descriptors remain the same," observes Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver.

Hunt here: The AMA moved the codes from after the vaccine/toxoid subsection to in front of the chemotherapy subsection. "In order to assist users in more convenient comparison and use of the infusion services procedures, codes 90760-90779 have been deleted and renumbered for proximity to the chemotherapy and other complex infusion services reported with codes 96401-96549," states CPT Changes 2009: An Insider's View.

The relocated subsection starts off with hydration. If your office provides rehydration therapy, make sure you change the codes on your office ticket and system to:

- 96360 -- Intravenous infusion, hydration; initial, 31 minutes to 1 hour (1.57 RVUs)

- +96361 -- - each additional hour (List separately in addition to code for primary procedure) (0.46 RVUs).

With how much time staff may spend before giving a patient an intravenous immunoglobulin (IVIG) infusion, you might be tempted to add 99211, which pays approximately $19 (0.52 RVUs) to the claim. "The nurse always spends a lot of time checking the same issues, asking the same questions before giving a patient his monthly IVIG infusion in our office," relates a family medicine nurse practitioner. "Can I bill 99211 for supervising this work?" she asks.

"This would not be an appropriate application of 99211 for several reasons," responds Cindy C. Parman, CPC, CPC-H, RCC, principal at Coding Strategies Inc. in Atlanta:

- Code 99211 always bundles into drug administration codes performed on the same day (for Medicare and other payers). The National Correct Coding Initiative does not allow a modifier to bypass these bundling edits.

- AMA and CMS definition considers the pre-administration work (whether it is IVIG, chemotherapy, or other drug administrations) part of the drug administration service, Parman explains. Therefore, you should not separately bill the pre-administration work with a patient visit code.

Medicare eliminates any confusion that its preadministration IVIG HCPCS level-II code (G0332, Services for intravenous infusion of immunoglobulin prior to administration [this service is to be billed in conjunction with administration of immunoglobulin]) created. This code misled coders into thinking IVIG did not include the pre-administration work.

CMS is deleting G0332 for office and outpatient hospital sites of service effective Jan. 1, 2009, Parman reports. "The reimbursement for the IVIG products will include the preadministration services."

Bottom line: If you forget to cross G0332 off your charge ticket, you could incorrectly submit the code, overcharging your carrier $60-$70. Because physicians experienced difficulty acquiring and purchasing the IVIG product at the average wholesale price (AWP) due to a shortage, Medicare had created G0332, which reimbursed approximately $60-$70 (1.97 RVUs or $75 national rate) as an additional reimbursement mechanism. Upon evaluating the products- cost, CMS found the market for obtaining IVIG had stabilized, making payment for G0332 unnecessary.

You-ll be stuck with the IVIG procedure bill in 2009 unless you switch to new codes 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) and +96366 (- each additional hour [List separately in addition to code for primary procedure]). You still code the supply with the appropriate code from the J1561-J1573 series.