Medical Billing for Emergency Procedures

Knowing when to use code 90782 in emergency department procedures can help with your medical billing reimbursements. For example, if a doctor examines a patient in the ED for an injury, and injects a preventative tetanus toxoid, your first instinct might be to use 90782 as a modifier for this procedure.

But you would not receive a medical billing reimbursement because the incident to provision does not apply in the emergency department so you would not be able to justify having the doctor administer this injection. There would be no way to justify the medical necessity of such a shot.

However, when you are in an office setting the CPT intructs that you are to select the name of the procedure and or service that ids as best possible the service that was performed. You want to make sure that you report as accurately as you can the service that was performed rather than just approximate it. The more accurate code here would be 90703 which is Tetanus toxoid absorbed for intramuscular use.

Medical Billing Hint: It is better to not append to modifier 51 for multiple procedures, to vaccine product codes or to the administration codes. If there is a significant separate service that the doctor performs you should report that separately. Also make sure that you remember to append 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 code.