Primary Care Coding Alert

When family pracitioners administer injections unrelated to the primary reason for the patients visit, coding properly can be confusing. But family practices can gain reimbursement in such cases by pairing codes correctly and isolating the type of injection.

Vitamin Injections

If an established 50-year-old woman visits her family doctor for her monthly vitamin B12 shot, the visit should simply be coded as 99211 (office or outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services), or as 90782 (therapeutic or diagnostic injection; subcutaneous or intramuscular) and J3420 (injection, vitamin B-12, cyanocobalamin, up to 1,000 mcg), depending on insurance carrier requirements. But if she sees her family practitioner because she has a slight cold and while she is in the office receives her regular vitamin B12 shot, its a different story.

Kent Moore, manager of reimbursement issues for the American Academy of Family Physicians (AAFP), says to code 90782 and J3420, the former being the code for admin-istration and the latter for the actual contents of the syringe.

In addition, the family practitioner should code 99212 (office or other outpatient visit for the evaluation and management of an established patient which requires at least two of the these three key components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making), along with modifier -25 (see the November 1999 issue of Family Practice Coding Alert, page 1) to indicate the treatment of the cold that required a significant, separately identifiable E/M by the same physician on the same day of the procedure or other service. Moore cautions, however, that Medicare may not allow both the E/M office visit code and the administrative code for non-vaccines, while commercial carriers may allow it.

Antibiotic Injections

If the therapeutic or diagnostic injection was specifically for an antibiotic, such as penicillin, use code 90788 (intramuscular injection of antibiotic) for the administration, and J2540 (injection, penicillin G potassium, up to 600,000 units) or J0530-0580 (injections for benzathine and penicillin G procaine) representing the actual substance.

(See cover story on CPT 2000 for an explanation of the change in 90472.)

Mary Rardin, MD, clinical assistant professor in the department of family medicine at the University of Kansas School of Medicine, says if you code an E/M service as well, remember it cannot be increased just because an injection was given at the time of the visit; instead, the complexity of the presenting problem determines the level.

Allergen Immunotherapy Injections

If a patient comes to the family doctors office for just an injection for allergies to grass and pollen, Joseph Lotharius, executive director of the Joint Council of Allergy, Asthma and Immunology, recommends using 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens) along with 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 (two or more injections).

Lotharius notes that 95117 refers to two or more injections and just that, meaning payment remains the same regardless if the patient is given two or seven injections. E/M office codes with modifier -25 may also be used in addition to the allergen immunotherapy if other identifiable services are provided at the same time.