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Coding Consult: Calling--and coding--the shots


Injections, infusions, allergy shots, and vaccinations all require specialized coding.


Coding Consult

Calling—and coding—the shots

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Choose article section... Allergy shots and vaccines Trigger point, joints, cysts, and pain

• 90782 isn't a catchall code for injections.

• Use 95115 or 95117 when you give allergy shots; they pay better.

• Use G codes when billing Medicare for vaccine administration.

There's no catchall code for injections and you've got to use correct ones for the best reimbursement. CPT notes that you should use 90782 for a "therapeutic, prophylactic, or diagnostic injection (specify material injected); subcutaneous or intramuscular." Examples of shots that meet these criteria include vitamin B12, Demerol, or antinausea drugs. But 90782 is the wrong choice for some types of injections, and it often pays less than the correct code.

If you give an antibiotic, use another code in this same series, 90788 (intramuscular injection of antibiotic [specify]), which pays a few pennies more. Other instances when 90782 is inappropriate: infusion therapy and other IV injections, allergy shots, vaccine administration, trigger point injections, and arthrocentesis/joint injections.

Confusing infusion and injection can be costly. Use the infusion codes 90780 (intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and 90781 (each additional hour, up to eight [list separately in addition to code for primary procedure]) when a patient receives IV drugs for a prolonged period. Make sure to note your units for all subsequent hours.

When you give a patient an injection directly into a vein—rather than through an infusion—use a code from the injection series, 90784 (intravenous).

Allergy shots and vaccines

Allergy shots have their own series of codes, and they pay better than 90782. Use 95115 (professional services for allergen immuno-therapy not including provision of allergenic extracts; single injection) when you administer a single allergy shot. Use 95117 (two or more injections) when you give the patient more than one shot.

Often, an allergist will supply the antigen, but if you mix it, you can also code 95165 (professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]), says Charol Spaulding, vice president of Coding Continuum in Tucson, AZ.

One of the most common injection-coding mistakes is using 90782 to code the administration of a vaccination. Both CPT and Medicare have special codes for vaccine administration, and you should use those codes instead. They pay the same amount as 90782.

For private payers, use 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for administration of one vaccine. Use 90472 (each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) for each additional vaccine given.

Medicare specifies codes for administration of flu, pneumonia, and hepatitis B vaccines: G0008 for influenza virus, G0009 for pneumococcal vaccine, and G0010 for hepatitis B vaccine.

"Many doctors who are familiar with 90471 are unaware of Medicare's G0008 code," says Karen Jeghers, manager of Compliant Billing Services in Carver, MA. "If you use just 90471, Medicare will deny the claim," Jeghers says. Offices that receive a denial of 90471 often write off the cost under the mistaken impression that Medicare doesn't pay for vaccinations. If you make this mistake, Jeghers advises that you resubmit with the proper G code.

Also, remember to code for all required doses of a vaccine. For example, Spaulding says, the hepatitis B vaccine often requires additional doses.

Trigger point, joints, cysts, and pain

Physicians sometimes give patients trigger point injections to ease pain in various muscles. Choose 20552 (single or multiple trigger point[s], one or two muscles) or 20553 (single or multiple trigger point[s], three or more muscles) depending on the number of muscles you're treating.

Report those codes one time per session, regardless of the number of injections given. They pay significantly more than the general injection codes.

Code joint injections for pain with the 20600* series (arthrocentesis, aspiration and/or injection . . .). Use 20600* for small joints, 20605* for intermediate joints, and 20610* for major joints.

One of the trickiest aspects of using this series is choosing the right code for the joint size, Jeghers says.

"Many people think of the wrist as a small joint, but it actually is intermediate," Jeghers says. Finger and toe joints are considered small, elbows and ankles are intermediate. Major joints are the shoulder, hip, and knee.

In addition to the proper CPT code for the injection, also use the J code for the drug or substance administered. Lidocaine is considered to be an inherent part of any procedure, so you can't bill for it separately.

To report multiple ganglion cyst aspirations and injections, use the new 20612 (aspiration and/or injection of ganglion cyst[s] any location) for each procedure performed, and append modifier –59 (distinct procedural service) to all but the first aspiration or injection to show that you're coding more than one of these procedures.

Some physicians try to use the arthrocentesis or nerve block codes (64400-64530) for acupuncture-like treatments for pain, but "you can't use these codes for dry needling," Spaulding says. The correct code for insertion of dry needles is 97780 (acupuncture, one or more needles; without electrical stimulation) or 97781 (with electrical stimulation), but most payers don't cover them, Spaulding says.


This information 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 www.codinginstitute.com.


Coding Consult: Calling--and coding--the shots. Medical Economics May 9, 2003;80:24.

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