Question: How should I code for Lopressor that is administered intravenously in the office?
South Carolina Subscriber
Answer: Lopressor (metoprolol tartrate) is a beta blocker used to treat high blood pressure, angina and heart attack. There is no HCPCS code for the medication. Therefore, you should report J3490 (Unclassified drugs) when supplying this drug. When billing for its use, be sure to include the product description and the National Drug Code number with your claim. You may also have to include the invoice, depending on your carrier's requirements.
If you only provide the intravenous infusion during the office visit, you should bill the J code for the medication and 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour). However, if you also provide E/M services while the patient is in the office, you should report the appropriate E/M code (99201-99215). Reimbursement for the infusion is included in the E/M payment, but you should still report the J code to receive payment for the drug supply.
On the other hand, if the cardiologist performed the E/M service for a reason unrelated to the patient's high blood pressure (e.g., pacer check), you should report both 90780 and the E/M code, along with J3490. In addition, you should append the E/M code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show it was distinct and separate from the Lopressor infusion.