Ambulatory Coding & Payment Report
Reader Questions: Check With FI When Billing Injections
Question: When we report 36000, the National Correct Coding Initiative (NCCI) prevents us from using codes 90784 and Q0081. There is no APC payment for 36000. How should I bill these?
Mississippi Subscriber
Mississippi Subscriber
Answer: Code 36000* (Introduction of needle or intracatheter, vein) is automatically included in both Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit) and 90784 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous), which is probably why your fiscal intermediary (FI) isn't paying you for the latter two. Coders are frequently confused about billing injections and infusions, ultimately because no die-hard standard exists what you get paid for is up to your FI.
Some FIs do not allow you to bill Q0081 and 90784 together because the reimbursement for each includes facility expenses, supplies, some medication, and nursing care so according to them, reporting both codes would be double-billing.
If you're billing Medicare, know that CMS has considered 90784 and Q0081 mutually exclusive since Jan. 1. This policy has created significant reimbursement loss at many facilities whose FIs have implemented the edits, and the agency is still reviewing the issue.
Your best shot is to contact your FI and find out what it will reimburse. Most likely, if the physician performed the injections/infusions during the same session, you should bill only one, but if they took place during different sessions in the same day, use modifier -59 (Distinct procedural service) to indicate to the insurer that one of the injections/infusions constitutes a distinct procedural service.
- Published on 2003-06-01
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