Answers to your questions ... Modifier -57; A dressing change; Multiple injections

August 18, 2006

Coding Consult

Modifier –57

Q. I diagnosed a common wart on a patient's hand and then used cryosurgery to remove the lesion. Should I attach modifier –57 (decision for surgery) to the E&M code?

Link both 99212–25 and 17000 to ICD-9 code 078.10 (other diseases due to viruses and Chlamydiae; viral warts, unspecified).

A dressing change

Q. A patient saw my nurse for a dressing change on a skin tear that didn't require sutures. Does a specific code exist for this procedure, or should I use 99211?

A. Report 99211 (office or other outpatient visit for the evaluation and management for an established patient, that may not require the presence of a physician . . .). And make sure the service meets any additional payer incident-to requirements. For instance, to report 99211 to Medicare, you must provide direct supervision, be managing the patient's wound care, and have authorized the treatment care plan.

If the service doesn't satisfy the insurer's incident-to policies, you shouldn't charge the patient for the dressing change.

Multiple injections

Q. I diagnosed a patient with bronchitis and gave him a Rocephin injection because of his other health issues. The patient also received a B-12 shot for pernicious anemia. Should I report the injection code 90772 more than once? And if so, should I use units or a modifier?

A. When a patient receives multiple injections, you should report each injection using 90772 (therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Code 90772's descriptor specifies "injection," not "injections" plural.

Whether you should use units or a modifier to report more than one therapeutic, prophylactic, or diagnostic injection depends on the payer. Some payers may require units, such as 90772 x 2. Others will prefer a modifier on the second injection code, probably –59 (distinct procedural service) to indicate the B-12 injection as occurring at a separate site from the Rocephin shot. Check with the insurer before sending in the claim.

You can help identify the injections as separate services rather than accidental duplicate billing by using different diagnoses. For example, link the Rocephin injection (90772) to a bronchitis ICD-9 code (such as 466.0, acute bronchitis). Report the B-12 injection (such as 90772–59) with its associated diagnosis, such as 281.0 (pernicious anemia).

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com.