Primary Care Coding Alert

Question: I have a patient who receives Delestrogen, 40 mg. My understanding is that we should assign HCPCS code J0970 for the medication, 90782 for administration, and 627.2 for the diagnosis. Is this correct? Also, if the patient furnishes her own serum, do I just bill 90782 or is there another code I should use?

Nebraska Subscriber

Answer: Medicare will allow you to bill for the drug and the administration only if you provide no other services at the time of the visit. Medicares reasoning is that reimbursement for administering a drug would be bundled into the payment for the other services performed.

Therefore, if your patient was seen only for this purpose, your coding scenario is correct. You would report J0970 for Delestrogen 40 mg and 90782 for the administration of the Delestrogen if no other professional services are billed. Code 627.2 (menopausal or female climacteric states) is appropriate to link with both J0970 and 90782.

But if the patient saw the physician for a problem-oriented visit (99201-99215) and also received Delestrogen, you would bill only the appropriate evaluation and management visit and the J code for the drug administered. You would not be able to code 90782 for the act of administering the Delestrogen. Most other carriers also follow these same guidelines, but you should make a point to check with local carriers to confirm their requirements.

Finally, you are allowed to bill only for medications or serum that your practice purchased. Therefore, if the patient provided the Delestrogen, your practice should not report or expect payment for the J code.

Answered by Cynthia DeVries, RN, BSN, CPC, a coding and reimbursement coordinator for Lee Physicians Group, a 140-provider, multispecialty practice in Fort Myers, Fla.