Proper use of 90782 billing code

Proper use of 90782 billing code

Like any other medical billing code, there is an appropriate time to use the current procedural terminology code 90782. Some people wonder if this code is appropriate when doing medical billing for a tetanus toxoid injection in the emergency room. In medical billing, the best CPT code is the code that most accurately describes the service.

In the emergency room scenario, it would not be appropriate to do medical billing for a 90782 (Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscularly) for a tetanus shot. In the emergency room, it would be very difficult to prove it medically necessary for a physician to administer the injection. A much more appropriate code for medical billing is 90703 (Tetanus toxoid absorbed, for intramuscularly use).

If the tetanus toxoid injection is performed in a clinic or office, it is appropriate to use 90782 along with the 90703 current procedural terminology code. This charges for the shot itself and does medical billing for the actual administration as well.

It is important to note that medical billing should not include modifier 51 in this instance. Modifier 51 means: multiple procedures. If your physician does perform a separate evaluation and management exam in addition to administering the tetanus shot, you can use modifier 25. Modifier 25 in medical billing means: Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

A general medical billing rule of thumb is to always use the most accurate CPT code for the service. If there is a code that only kind of explains a procedure, you can probably find a better one. 90782 is a perfect example of a medical billing code that can be overused. You medical billing staff members must know the difference between a semi-descriptive code, and the perfect code.

View all Articles by: Melissa Clark, CCS-P