Three Questions Solve IM Injection Medical Billing Challenges

CPT 2006 injection administration coding instructions require that you verify the OB-GYN’s involvement in order to report 90772, or in order to submit the non physician performed procedure as 99211, or it could depend on the payer’s incident-to policies, and possibly be returned to you as a no charge.

To determine which code applies to injection administration, you need to ask yourself three questions.

1. Is the Doctor in the office and available during the injection? If the answer is yes, the OB-GYN provided direct supervision throughout the subcutaneous or intramuscular injection, then you can report 90772 (which is therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). The CPT adds this requirement in an instruction that follows 90772 that indicates you should not report 90772 for injections that are given without direct physician supervision. An injection administration encounter that does not meet the direct supervision criteria should instead be reported as 99211. According to the CPT instructions following 90772. Note that the physician does not need to be present in the exam room during the procedure to bill 90772.

2. Does documentation support the MD’s presence? You should consider coding a nurse visit instead of an injection administration if you do not have supporting documentation that shows the OB-GYN was in the office and immediately available. The scheduling record should show which OB-GYN was present in the office suite at the time of the injection administration.

3. Does the insurer allow 99211 with lower level supervision? You should check a company’s incident-to rules before you use 99211 without direct physician supervision.

View all Articles by: Melissa Clark, CCS-P