Injections and infusions – I had some help with this from Jo-Anne Sheehan. She was going to help us present, we’re actually going to have her join us regularly to present, but her father-in-law is in the hospital right now, so that took precedence understandably. So, I’m going to try and go over her answer sheet she did for us.
Q: Hello! My employer wants me to start coding injections and infusions soon and I want to learn as much as I can. I do have my CPC and my CCS, but I have not done this yet at the workplace. Is there something CCO offers?
A: So, first of all, thanks for thinking of us first for your educational needs. We don’t really have anything kind of wrapped up, so hopefully this little segment will help you. And I’ll pull up my answer sheet very thorough from Jo-Anne. So, what she did is she took things from different sources and kind of came up with her own little cheat sheet. She did say to really make sure you check with your top payers that your practice is interfacing with to make sure these guidelines fit.
Starting off with Injections and E/M, this is an area that new coders tend to get a little confused on. So, basically: An E/M service is an integral component of a diagnostic or therapeutic injection. Reimbursement for an E/M service is therefore included in the payment allowance for diagnostic and therapeutic injections. And it goes on, but here in bold: the injection code will be reimbursed unless a significant, separately identifiable E/M service has been performed. If that’s the case, then modifier-25 should be appended to the E/M code and both the E/M code and injection service will be reimbursed.
So, my little rhyme that I teach during my coding course for the Blitz is “If you don’t have a HEM (History, Exam, Medical decision making) you can’t bill an E/M.” So, look at your source document, do you see history clearly documented, and exam clearly documented and medical decision making clearly documented? In addition to, in this case, an injection or infusion note; then, you can bill both. If you don’t, and it’s all just about the injection, then just bill the injection.
Injections and Infusions Medical Coding
Now, there are some exceptions, Preventive Medicine, E/M codes, (99381-99429) include routine services such as the ordering of immunizations or diagnostic procedures, which are not considered included in the preventive E/M service. Preventive E/M codes may therefore be reported in conjunction with injection service codes, and modifier-25 is not needed on those.
I kind of view modifier -25 as regular E/M code not like preventive medicine ones. By “regular” I mean, the HEM-based ones (history, exam, medical decision making), they got those three bullets in them.
Then, E/M code with 99211 – 99211 is what’s referred to as the nurse visit code; it’s that 5-minute quickie code. That will not be reimbursed when submitted with an injection code.
Injections and Medications – Medications provided at the time of the diagnostic and therapeutic injection should be reported… When I teach this in the Medicine section, I called it “stick and stuff” and that helped me when I was new at coding to remember that when you’re talking about injection there’s normally two pieces to the story: what you’re injecting into the patient and the service of sticking it to them. So, if that helps, just think “stick and stuff” or what they call administration and the product. And so, this is just that reminder permission statement that you can bill for the product separately.
Injection & Infusion Services and Supplies – Standard tubing, syringes, and other supplies are included in the injection or infusion service code. So, you don’t want to try and bill for them separately and they are considered incidental. Therefore supply codes submitted with codes for the following services will not be separately reimbursed when submitted by the same physician or other healthcare professional…
Injection and Infusion Services Include: the injections themselves, hydration (sometimes they put saline in), therapeutic, prophylactic, and diagnostic infusions, chemotherapy, and other highly complex drug or highly complex biologic agent administration.
The specific CPT codes associated with the injections and infusions provide very specific guidelines for initial use and each additional hour. So, be led by what CPT is telling you for how to code the initial hour and subsequent ones. And if they’re doing concurrent infusions, it’s all laid out right there in the CPT.
The last one: Remember that these guidelines represent many payers; so it’s always in the best interest of the provider to verify coverage and coding guidelines for the specific payers that you’re associated with. I normally recommend calling your top four and making a note of what they say on how to handle that, and do that for any particular thing that you’re researching that’s popular in your practice. So, hopefully that will help.
I noticed in the chat, two people are asking about these answer sheets and the slides. For this live free webinar, we don’t provide it. We will give you links here and there, but for the most part, we’re developing these answer sheets for our Replay Club members. Our Replay Club is $19.95 a month and you can cancel it anytime and we provide a full recording of this webinar broken into the segments, a little video clips of each topic; so it’s real easy to drill down and get to what you want, and then all these answer sheets that are nice pretty PDF format that, again, Ruth is an integral part of putting it together.