Pulmonology Coding Alert

Question: When the physician performs an intramuscular injection, when can I report 90782 for the injection and also a separate evaluation and management service?

Arizona Subscriber

Answer: Medicare will pay for 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) if your physician performed no other service payable under the Physician Fee Schedule during that patient encounter.

If the physician provided additional services, such as an evaluation for wheezing, Medicare will consider 90782 bundled into the appropriate E/M code (for example, 99201-99205, 99211-99215). Be sure to report the appropriate HCPCS code to represent the injected material. You can receive payment for the drug but not necessarily the administration.

Exception: Private payers that don't follow Medicare rules may reimburse 90782 and an E/M code. But the pulmonologist should provide a compelling reason and significant medical necessity for the physician to be intimately involved with the injection, and it must have supporting documentation.

-- Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan Plummer, MD, chief of pulmonary disease, allergy and critical care at Emory University Hospital in Atlanta.