Pulmonology Coding Alert

You might think that you can use 99070 as a catchall supply reimbursement code. The real trick is to stay away from it as much as possible and open your doors to other, more specific supply codes. When you are tempted to put forth 99070, make sure you verify the following checklist first.

You can bill 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drug, supplies, or materials provided]) only if you incurred an uncompensated cost in an office setting (POS 11).

For instance, if your pulmonologist performs a thoracentesis (32422) at an outpatient hospital (POS 22), the facility would capture payment for the technical costs such as the thoracentesis tray, extra lidocaine, tape, and bandages because it would supply these items. Therefore, the physician can bill for the procedure in the facility setting but is not compensated for the supply (about $123.41 reimbursement).

If this were performed in the office setting (POS 11), the physician receives $190.89 to account for the physician's practice expense and supplies. In this case, do not report 99070.

Why: The AMA and Medicare already account for the supplies within a CPT code's value on the physician fee schedule. The non-facility rates, such as POS 11, have a higher payment rate to adjust for overhead costs incurred by physicians, says Michelle Logsdon, CPC, CCS-P, at Falcon Practice Management in Toms River, N.J.

"If you're doing a procedure in the office that requires tools, surgical trays, or other supplies, the reasonable expectation is that you will be using equipment and that those costs have been accounted for in the procedure code reimbursement," Karla M. Westerfield, business manager at Southeast Wyoming Ear, Nose & Throat Clinic in Cheyenne, explains.

There are times when an alphanumeric (HCPCS) code may be the better option. Not to mention, using 99070 means you'll have to endure more paperwork, such as noting the item's description and attaching a copy of the invoice.

Example: A nurse gives a 0.3-cc epinephrine shot to a child following an allergy attack from a yellow jacket sting. You would code the drug with J0170 (Injection, adrenaline, epinephrine, up to 1-ml ampule). Using J0170 instead of 99070 more clearly identifies the medication and should speed up the reimbursement.

Don't forget to report the physician's E/M service with 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient ...) and the injection administration with 96372 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

When an encounter requires more supplies than usual,you might code them, although it is rarely appropriate. One scenario when using 99070 is appropriate is when a patient self-administers allergy injections and cuts back the amount of extract per injection, says Westerfield.

"For instance, if we give the patient 10 needles for 10 doses and they actually break the 10-dose extract into 20 doses, we will charge 99070 for extra syringes, along with exploring the patient's reasons for reducing the amount of extract per injection," she adds.

Look out: This may be rarely permissible, if at all, Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia, warns. "The patient may be required to obtain the syringes from their pharmacy as a regulatory control," she says.

Again, you're better off using a HCPCS level-II supply code, rather than CPT's miscellaneous supply code. If no specific code exists, you can use the generic code (99070).

Note: Make sure you include the item's name on the form and be prepared to submit a copy of the invoice.

Warning: Not all insurers, however, accept the generic code even with documentation. Some East Coast coders, in fact, haven't been receiving payments for billing 99070. When this happens, the office collects from the patient at the time of service. In particular, this may not be acceptable if the reason for denial is due to the fact that payment for the practice expenses are included in the general payment for the procedure.

If you code for a hospital-owned clinic or practice, let the facility handle the supply coding. The practice has a contract with the hospital, therefore the hospital bills for all drugs and supplies. The practice reports only the physician's services.