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Avoid Hazards in Coding Multiple Injections

Coding for multiple injections presents a number of hazards under OPPS, says
Mary Lou Bowers, MBA, LCSW, a managing director with ELM Services Inc., an oncology consulting firm in Rockville, Md. Unbundling errors occur frequently in radiology, ambulatory surgery, oncology and gastroenterology -- specialties that often use injections. The errors are caused by confusion among both providers and many FIs about how to document injections and when bundling is appropriate.

To Bundle or Unbundle

Coders and billers have to be alert for bundled services, Bowers says. In some cases, injections should be billed separately, but in other cases they are bundled into the payment for a major service. Under OPPS, injections are assigned X status (ancillary services billed on a unit basis) because injections are usually part of a significant service or procedure and would be bundled into the payment for that procedure. Injections, therefore, should normally not be billed separately.
 
For example, CPT code 11950 (subcutaneous injection of filling material [e.g., collagen]; 1 cc or less) is a bundled service that includes both the procedure and the injection, Bowers says.
 
But in some cases, for distinct medical reasons, injections are provided as additional services on the same day as a significant medical procedure is performed and should be billed. For example, J3420 (injection, vitamin B12 cyanocobalamin, up to 1,000 mcg) is not a bundled service and is billed separately. Bowers recommends that coders review the CCI edits to check whether the dyes or injections being used are already bundled into the code they submit for payment. If they are bundled, then billing is inappropriate. 

When To Use Modifier -59
 
"The correct modifier for injection services is always -59 (distinct procedural service)," Bowers says. For example, a cancer patient might have a diagnostic test that includes an injection of some medium on the same day that he or she receives supportive drug therapy such as epoetin alpha. Bowers says the injection for the epoetin alpha can be billed but must have a modifier to show that it is distinct from the radiology injection. It would be incorrect to bill the radiology-medium injection because, as in the case of epoetin alpha, it could be part of an infusion-therapy service, she adds.
 
Note: Injections may be reported in multiple units on the same line of the claim form, so you do not need modifiers for multiple injections.
 
"The service department, such as radiology, has to be responsible for educating the support departments (such as billing and compliance) about items that are routinely included in the service, so that everyone understands and agrees on [...]

- Published on 2001-08-01