Know the difference between 90782 and 90471 - or face denials
Internists often give injections, and that means you should understand when and how to report a number of injection codes. Follow this expert advice to code shots for B12 vitamins, vaccinations and pain.
1. B12 Injections: Understand Tricky Coding Policies
Although coding a B12 injection may seem simple, the different carrier guidelines make reporting this service - and getting paid for it - frustrating for many IM practices.
Most Medicare payers, such as Noridian Administrative Services, accept 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular]) for the B12 administration, and J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg) for the drug.
But nearly all Medicare and private carriers will not pay for the injection code if you report an E/M code, such as established patient code 99211, on the same day. This applies even if you 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 the E/M.
"I would not recommend reporting an E/M with a B12 shot," says Lisa Center, CPC, quality review coordinator for Freeman Health System in Joplin, Mo. "If the nurse gives only a shot, I would bill only for the administration (90782) and drug code (J3420)."
Remember that CMS includes the same number of RVUs that 99211 carries with 90782, effectively bundling the two codes. In addition, Medicare generally reimburses for 90782 only if the physician bills for no other payable service on the same day. Exception: You can also report the drug code J3420.
Caution: "On rare occasions when the patient brought in the drug, and we billed only 90782 without the J code, Medicare as well as other carriers occasionally rejected the claim," says Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla. But Medicare paid after an appeal, she adds.
"I am sure that they thought we wouldn't appeal such a small dollar amount, but we appealed everything based on principal," Pride says. "If we deserved to get paid, no matter how big or small the amount, we fought for it."
Good news: If you're able to report 90782, you should expect more payment than in previous years. Reimbursement for the code ranges from $25 to $40, depending on location. This price is up from the $3 or $4 most insurers once paid.
2. Know Which Vaccine Codes Payers Accept
If the physician administers a vaccination, make sure you know whether the patient has a private or Medicare insurer before you assign a code.
Typically, Medicare pays only for flu, pneumonia and hepatitis B vaccine codes: