Primary Care Coding Alert

Action: Code multiple 90772s the same way you coded 90782s

The financial health of many family practices depends on knowing how to correctly code multiple therapeutic injections -- and CPT 2006 has thrown a major wrench in reporting these services.

Therapeutic, diagnostic and antibiotic injections rank in the top-50 procedures family physicians perform. -We administer a lot of injections,- says Beverly Haun, CMOM, for Paul Grayson Smith Jr., DO, PC, in Cleveland, Tenn. Experts show you a surefire way to collect your deserved multiple injection reimbursement with 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

Step 1: Assign 90772 per Injection

The key to accurate reimbursement for multiple injections is recognizing that you can report 90772 more than once. The code's descriptor specifies -injection,- not -injections.- Because the definition refers to a single service -- injection singular, instead of injections plural -- -the AMA intends 90772 to cover a single injection,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Catch: The service must meet CPT's criteria for 90772. Staff must administer under direct supervision, so the FP must be in the office throughout the procedure.

Strategy: If an insurer questions billing 90772 multiple times, you have two tools on your side: 90772's descriptor and a CPT Changes vignette. Send the payer 90772's definition highlighting injection singular and the following example.

-A 19-year-old male presents with severe dysuria. A urethral swab is performed and found to be consistent with gonorrhea,- according to page 26 of CPT Changes 2006 -- An Insider's View, published by the AMA. The procedure description states, -The physician provides direct supervision and is immediately available in the office. The physician assesses the patient's response to treatment.-

Step 2: Apply Insurer's Multiple 90782 Method

Whether you should use units or a modifier to report more than one therapeutic, prophylactic or diagnostic injection depends on the payer. Do this: Report the injections using the method you previously used with 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).

-Because 90772 replaces 90782 and G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), you should bill 90772 as you did for multiple injections last year until a policy comes out,- says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa. Coders should not change the way they bill for this service, just the CPT code they use, she says.

Idea: Make a list of your major insurers- 90782 multiple billing requirements and apply them to 90772 multiple services. Expect some payers to require units, such as 90772 x 2. Others will prefer a modifier on subsequent injection codes, probably 59 (Distinct procedural service), Falbo says. Modifier 59 would indicate that the second or third injection occurred at a separate site from the initial shot.

How to do it: An FP diagnoses a patient with bronchitis and gives him a Rocephin injection due to other medical health issues. The patient also receives a B-12 shot. If the insurer accepted units with 90782,  you should assign 90772 x 2 on claims in 2006. For payers that required modifier 59 to represent two 90772 charges, report 90772, 90772-59.

Tip: You can help identify the injections as separate services, rather than accidental duplicate billing, by using different diagnoses. Here's how: When coding the above Rocephin and  B-12 injections scenario, you should:

- link the Rocephin injection (90772) to the bronchitis ICD-9 code (such as 466.0, Acute bronchitis).

- report the B-12 injection (such as 90772-59) with the associated diagnosis, such as 266.2 (Other B-complex deficiencies).