Pulmonology Coding Alert

AMA replaces these codes with several more-specific codes

If your pulmonologist performs drug infusions, you'll need to change how you report those services starting on Jan. 1. CPT 2006 deletes 90780-90784 and replaces them with new hydration, therapeutic, prophylactic, and diagnostic drug injection and infusion codes.

This change gives coders more of a selection of CPT codes when a physician administers saline or medication intravenously, says Mary Beth Wass, MS, CMM, manager at The Asthma & Allergy Center in Papillion, Neb.

Use 90760, 90761 for Hydration Services

Codes 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and +90781 (... each additional hour, up to eight hours) have been deleted, making way for more specific codes:

• 90760--Intravenous infusion, hydration; initial, up to 1 hour

• +90761--...each additional hour, up to 8 hours.

You'll use these two new codes for hydration-related services that your pulmonologist provides. You can report 90760 and 90761 for hydration IV infusion of prepackaged fluid and electrolytes, such as saline, but not for the dilution infusion of drugs. As with the old IV infusion codes, 90760 and 90761 require direct physician supervision.

Report 90765-90779 for Drug Administration

In 2005, you had to use codes 90782-90784 or temporary G codes G0345-G0358 to report drug administration services. CPT deletes 90782-90784 for 2006 and offers nine new drug administration codes. 
 
The new drug injection codes are specific to the type of administration (i.e., intravenous, intramuscular, or subcutaneous) and whether the injection is an initial, sequential or concurrent administration. Reporting these codes also requires direct physician supervision.

Tip: If a patient receives a subcutaneous injection of omalizumab (Xolair) under direct supervision of the physician, report 90772. But if there is no direct physician supervision, CPT directs coders to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) instead of 90772.

You should also report J2357 (Injection, omalizumab, 5 mg) for each 5 mg of Xolair given. Note, however, that certain insurers also require direct physician supervision in order to report 99211 as well, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Note: The new codes 90772-90774 have essentially the same descriptors as the old codes you used, except that 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) and 90788 (Intramuscular injection of antibiotic [specify]) are now combined under the new 90772.

Example: When a patient is having an acute asthma episode, the physician may order an IV push of SoluMedrol, Wass says. You'll now report this type of service using 90774 for the initial infusion and 90775 if the pulmonologist uses the same method to administer additional medication.

New Unlisted-Procedure Code Adds Detail

CPT deleted 90799 (Unlisted therapeutic, prophylactic or diagnostic injection), making way for 90779 (Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion). The new code descriptor includes more detail in that it specifies "diagnostic intravenous or intra-arterial or infusion" instead of just "diagnostic injection."