Coding Consult

November 19, 2004

Answers to your questions about...injections; global days; hospice modifiers; CPAP checks

A You're reporting the wrong code. You should use vaccine code 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for the first injection. To report each additional injection during the same visit, assign 90472 (. . . each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]).

Report 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for injections not otherwise represented by a specific CPT or HCPCS code, such as immunizations or chemotherapy.

A The National Correct Coding Initiative does not bundle these codes, but the physician fee schedule gives 49080 (peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) no global days. This means that if you perform any E&M service, such as 99233 (subsequent hospital care, per day, for the evaluation and management of a patient . . .), on the same day as the peritoneocentesis, the payer will likely consider the E&M part of the procedure.

The exception is if you report the E&M as a separately identifiable service. In that case, you could attach modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99233 but make sure your documentation supports the charge.

Hospice modifiers Q What is the difference between modifiers -GV and -GW?

A Use modifier -GV (attending physician not employed or paid under arrangement by the patient's hospice provider) when you provide services related to a hospice patient's terminal illness and don't receive compensation from the hospice service.

Whether or not you work for the hospice, when you treat a patient for conditions unrelated to a terminal illness, you can use modifier -GW (service not related to the hospice patient's terminal condition). But if you treat the same patient for the terminal cancer, and are not paid by the hospice, you should use modifier -GV.

CPAP checks Q When a patient comes to the office and the respiratory therapist completes a pressure check on her continuous positive airway pressure equipment, should we bill 94660?

A No, only report 94660 (continuous positive airway pressure ventilation [CPAP], initiation and management) for the initiation and management of CPAP ventilation. If a respiratory therapist, NP, or PA checks the equipment and reviews the information with the patient, bill the appropriate E&M code, 99211.

If you see the patient yourself on the same day the respiratory therapist checked the equipment, you could bill an E&M service for the visit but not for the therapist's work. If she checked the equipment, and you didn't see the patient, you can bill only for her service.

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