Coding: Your Top Coding Concerns Solved<

by: Betsy Nicoletti

Billing for and administering medications

Most of you already know that practices can bill for intramuscular (IM) and intravenous (IV) medications they purchase and administer to patients. But because the profit margins for these services are slim, it's important to understand how to code for them and how to best follow up on denials.

Some medications are easy to bill for. If your practice prepares an allergy serum, you bill the codes starting in the 95120 series; if your practice purchases immunizations rather than receiving them free from the state, use codes 90476 to 90479 when administering them.

Codes for additional medications can be found in the HCPCS book. (There are multiple vendors for this resource; just Google "HCPCS.") This book, updated annually, describes medicines and the dosages that define a single unit. For example, one unit of dexamethasone acetate, J1094, is defined as 1 mg. If you give a 2 mg dosage, you can bill for two units.

Sometimes you correctly submit claims for administering multiple units to a payer, only to have that payer process a single unit. To guard against this, when you post for such a payment, double-check for any mistakes, and appeal or resubmit any under-reimbursed claims for full payment. If you don't do this every time, your practice is likely losing money on medications.

If you use a paper encounter form, clearly list the dosage for a single unit of the drug you are administering, and ask your nursing staff to write the dosage given on each form. Make sure there is an up-to-date HCPCS book available in the clinical area and that someone knows how to use it.

Whether a drug is covered for a particular patient is determined by each payer's policies. For Medicare patients, the answer is often found in the "National Coverage Determinations Manual" or the "Local Coverage Determinations Manual." These policies, also available on CMS's Web site, describe the diagnoses and conditions for which certain treatments and medications are payable. So before you provide costly medications, always check with payers' Web sites or contact them to confirm their coverage policies.

Also remember that you can charge for the administration of IM/IV drugs in addition to the cost of the drug itself.

Bill for the administration of immunizations using CPT codes 90465 to 90474. Select a code by the method of administration - intramuscular or oral - and the number of immunizations given.

If you provide counseling to the parent of a child who is 8 years old or younger, use a different series of codes. These codes have a base code to indicate that one vaccine was administered and add-on codes for additional administration.

Medicare has its own vaccine administration code for many covered services. You can download the codes and guidelines from its Web site.

Bill allergy injections with 95115 for a single administration, and with 95117 for two or more administrations; 95117 is not an add-on code, but is used in place of 95115 when more than one injection is given in a single day. If your practice provides the serum, bill for that in addition to its administration. If the patient provides the serum, bill only for the administration.

Injections into joints are billed with codes 20600 to 20610. Bill for these medications in addition to the injection when your practice purchases the drug.

Many practices bill IM or subQ injections of many drugs with code 90772. Remember that a nurse visit, 99211, is bundled into 90772; don't bill it separately. You can bill a provider visit on the same day of the injection, assuming that you performed a full E&M service. Bill for the medication separately if you purchased it.

Don't lose the money you've earned. Review your medication coding and posting practices today.

For Healthcare Professionals