Primary Care Coding Alert

Understand the basics of reporting the new streamlined injection codes

Code 90782 ranks in the top-15 codes reported by family physicians--so it is crucial that you keep payment flowing for these claims using the new 2006 coding method that takes effect Jan. 1.

Old way: In 2005, Medicare issued a temporary G code to replace CPT's therapeutic injection code. For administration of a B-12 injection (J3420, Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg), you had to report G0351 to Medicare and 90782 for private insurers.
 
New way: CPT 2006's introduction of one new injection code (90772) ends the dual reporting that therapeutic injection services required and counts antibiotic injections as the same procedure.

The change will make coding injection administration easier, says Donna Struve, CPC, assistant manager for Sheldon Family Practice in Sheldon, Iowa. -Coders will no longer have to split out injection administration based on insurer.-

Take these steps to ensure you incorporate all the changes.

Step 1: Replace 90782, 90788 and G0351 With 90772

The first step you should take is to remove these injection administration codes, which will be deleted from CPT 2006, from your encounter sheet:

- 90782--Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular

- 90788--Intramuscular injection of antibiotic (specify).

HCPCS 2006 should also delete:

- G0351--Therapeutic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.

New method: Instead of choosing among 90782, 90788 and G0351 for injection administration, you should use a single code:

- 90772--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.

Important: Although 90772's descriptor doesn't specify -antibiotic,- CPT confirms that you should report injection administration of an antibiotic with 90772. -90788 has been deleted. To report, use 90772,- states CPT's notes following the -Therapeutic, Prophylactic, and Diagnostic Injections and Infusions- subsection.

Because CPT 2006 lumps therapeutic, prophylactic, diagnostic and antibiotic injections together, -coders will be able to remember one code for injection administration,- Struve says. You-ll also no longer have to determine whether to classify a particular drug, such as Rocephin, as 90782 or 90788.

Step 2: Ensure FP's Presence in Office Suite

Before using 90772, make sure a family physician provides direct supervision throughout the procedure. CPT has added this requirement in an instruction following 90772 that states you should -not report 90772 for injections given without direct physician supervision.- 

If the injection administration encounter does not meet the direct supervision criteria, you should instead report 99211, according to CPT's instructions following 90772. The directive indicates that -CPT has adopted CMS- direct supervision definition,- says Quinten A. Buechner, MS, MDiv, CPC, president of ProActive Consultants LLC in Cumberland, Wis.

Translation: The physician must be in the office setting and immediately available. The requirement does not mean the FP must be present in the exam room during the procedure to bill for 90772, Buechner says. -This level is higher than the general supervision [physician available by phone] requirements that shots, such as B-12 injections, require in 2005.-

Example: A patient who has a standing order for B-12 injections comes into the office in the morning for his injection. The FP is at the hospital making rounds.

In this situation, you should use 99211 instead of 90772, according to CPT rules. The procedure does not meet the direct supervision requirement because the physician is not present in the office suite.

Step 3: Check Payer's Incident-to Rules

Depending on your insurer, the above B-12 injection scenario may not qualify for 99211. -You should check a company's incident-to rules before using 99211 without direct physician supervision,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

CPT's 99211 directive could contradict insurers- incident-to requirements. -Although some payers follow CPT's more liberal rules and allow 99211 without direct supervision, CMS requires the physician provide direct supervision to bill a service incident-to,- Cobuzzi says.

The lowdown: Reporting 99211 for the above B-12 injection scenario hinges on the insurer's incident-to requirements. -If the patient is a Medicare patient, you should treat the injection as a no-charge service,- Cobuzzi says. You would report neither 90772 nor 99211.

Step 4: Substantiate Direct-Supervision Claims

The direct supervising FP does not have to be the physician who created the standing order. But to avoid 90772 repayments, make sure documentation can prove the physician's presence.

Best bet: -Have a stamp made that indicates -Supervisor present,- - Cobuzzi says. Then, the nurse can fill in which doctor was present during the injection administration. If Medicare requests documentation supporting direct supervision or audits your 90772 claims, the chart note will substantiate your charge.

The scheduling record should also show which doctor was present in the office suite during the injection administration.

Step 5: Understand CMS-Issued Temporary G Code

This pattern of annual medicine-code changes ends now. Medicare had to create G0351 and hydration G codes because the new CPT codes were unavailable in 2005.

Medicare issued the G codes to comply with the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) that required a review of the current codes. -The AMA's CPT Editorial Panel revamped the codes- but didn't complete the changes in time to include the new codes in CPT 2005, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa.

Instead of waiting until 2006 for the revamped CPT codes, -CMS (Medicare) felt it was necessary to incorporate the changes for 2005,- Falbo says. Now that CPT 2006 codes exist, you should use these codes for all insurers.