Pulmonology Coding Alert

Overlooking Synagis treatment change will delay $21 per claim

You can save countless hours in appeals work this spring if you take three steps to get your injection and intravenous codes in line.

For 2009, the AMA relocates the "Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions" medicine subsection and renumbers the codes. "The descriptors didn't change at all," notes Jill M. Young, CPC, CPC-ED, CPC-IM, with Young Medical Consulting, LLC, in East Lansing, Mich.

The AMA moved the codes from after the vaccine/toxoid subsection to in front of the chemotherapy subsection and combined both subsections' guidelines.

"In order to assist users in comparison and use of the infusion services procedures, codes 90760-90779 have been deleted and renumbered for proximity to the chemotherapy and other complex infusion services reported with codes 96401-96549," states CPT Changes 2009: An Insider's View.

There were no changes in the hierarchy, Young says. "CPT 2009 just put the codes in a more logical place. Here's where you can find them now.

The next time staff administers a Decadron shot to a patient, double-check that you're submitting 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

Reporting the injection administration with the 2008 version 90772 will trigger an invalid code rejection delaying approximately $21 in pay. (Figure based on the 2009 Medicare Physician Fee Schedule assigning 0.58 transitional non-facility total relative value units [RVUs] to 96372 and using a conversion factor of 36.0666.)

Error averted: Do not separately bill pre-administration work with a patient visit code.

The AMA considers the pre-administration work (whether it is IVIG, chemotherapy, or other drug administrations) part of the drug administration service, explains Cindy C. Parman, CPC, CPC-H, RCC, principal at Coding Strategies, Inc. in Atlanta.

For payers that adopt Medicare edits, 99211 always bundles into drug administration codes performed on the same day, Parman notes. The Correct Coding Initiative does not allow a modifier to bypass these bundling edits.

The relocated subsection starts off with hydration. If your office provides rehydration therapy, make sure you change the codes on your office ticket and system to:

• 96360 (Intravenous infusion, hydration; initial, 31 minutes to one hour); 1.57 RVUs or approximately $57.

• +96361 (... each additional hour [List separately in addition to code for primary procedure]); 0.46 RVUs or approximately $17.

You'll be stuck with the IVIG procedure bill in  2009 unless you switch from 90765 and +90766 to these new codes:

• 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour); 1.91 RVUs or approximately $69)

• +96366 (... each additional hour [List separately in addition to code for primary procedure]); 0.61 RVUs or approximately $22.