Injection coding is simpler in 2006. Here's what you need to know to make sure your claims are problem-free.
Now, CPT 2006 introduced one new injection code, 90772. Not only does this put an end to the dual reporting that therapeutic injection services required, but the new code also applies to antibiotic injections.
As of January, you should have replaced three injection administration codes-90782, 90788 (intramuscular injection of antibiotic [specify]), and G0351-with the single new code 90772 (therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). You use this one code regardless of the insurer.
Although 90772's descriptor doesn't specify "antibiotic," you should use the new code to report injection administration of an antibiotic. CPT added the directive in a small note at the end of the "Therapeutic, Prophylactic, and Diagnostic Injections and Infusions" subsection, says Christine DuBois, a certified coder and coding/compliance coordinator at Western Mass Physicians Associates in Chicopee, MA.
The note says, "90788 has been deleted. To report, use 90772." Because CPT 2006 lumps therapeutic, prophylactic, diagnostic, and antibiotic injections together, "you should have a simpler time coding injection administration. Using two separate codes for basically the same procedure isn't necessary," DuBois says.
J codes continue to identify which drugs you inject.
For example, say you give a penicillin shot to a patient with an upper respiratory infection. Last year, you would have had to remember to use 90788 because the drug is an antibiotic, along with a J code (such as J0530-J0580, injection, penicillin G benzathine . . .). Now, you just have to assign new code 90772 and the appropriate J code.
Be sure you bill for all the units you inject. If you inject more than 99 units, you may need to bill the drug on two lines on your claim form. This is because many third parties can't process more than two digits in the units field. So to ensure payment, split the units into two, putting 99 units on the first line and the balance on the second. Use modifier –59 (distinct procedural service) on the second J code line to indicate that this isn't duplicate billing. You may want to check with insurers to see how they handle this situation.
Direct supervision rules
If a staffer gives the injection, you can't use the new 90772 code unless you provide direct supervision, says Quinten A. Buechner, a certified coder and president of ProActive Consultants in Cumberland, WI.
The requirement doesn't mean that you must be present in the exam room during the procedure to bill for 90772. But it does mean that you must be in the office setting and immediately available, says Buechner. "This level is higher than the general-supervision [physician available by phone] requirement that shots like B-12 injections required in 2005."
The supervising doctor doesn't have to be the physician who created the standing order. But to avoid 90772 denials, make sure documentation can prove the physician's presence.
"Have a stamp made that says, 'Supervising physician present,' " says consultant Barbara J. Cobuzzi, a certified coder and president of CRN Healthcare Solutions in Tinton Falls, NJ. The nurse can then write which doctor was present during the injection administration.