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Charge appropriately for SQ/IM injections and IV push injections

APCs Weekly Monitor, March 21, 2008

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QUESTION: We would like clarification regarding subcutaneous (SQ)/intramuscular (IM) injections (code 90772) and intravenous (IV) push injections (codes 90774 and 90775).

For example, a patient receives five separate IM injections of morphine, two separate injections of Dilaudid (IM), two separate IV push injections of Lasix, and four injections of Ativan (IV push). How many units should we charge for codes 90772, 90774, and 90775?

ANSWER: Report code 90772 (therapeutic, prophylactic or diagnostic injection; subcutaneous of intramuscular) for singly prepared injections. The rule for same and different drugs does not apply to code 90772. If all orders and documentation are present, along with each singly prepared injection, then you should report code 90772 seven times-five times for the morphine and two times for the Dilaudid.

Due to medically unlikely edits (MUE), providers have experienced submission problems with code 90772 when they report seven units on the same date of service. We believe that a "fix" made by the National Correct Coding Initiative will be available beginning April 1, 2008. In the meantime, communicate this issue with your revenue cycle committee and speak with your fiscal intermediary. Monitor outpatient claims now and after April 1 to ensure that you are being properly reimbursed for the units of service you report.

For IV push drugs, prior to January 1, 2008, CPT rules stated that you should only report one IV push per drug or substance, regardless of the number of injections of the same drug administered. In the example above, you should report codes 90774 and 90775 once.

In January 2008, CPT issued code 90776-therapeutic, prophylactic or diagnostic injection; each additional sequential intravenous push of the same substance/drug provided in a facility. Parenthetical notes state that 90776 should not be:

• Reported for a push performed within 30 minutes of a reported push of the same substance or drug
• Reported by physician offices. It is for facility use only.

According to the American Medical Association directives on file, reporting 90776 depends on how the drugs are prepared and administered. Report multiple, individually prepared administrations as individual administrations. However, if the drug or substance is prepared one time and administered in portions, report the administrations as only one administration (e.g., code 90774). If the clinician administers a second, separately-prepared same drug in portions, then this would constitute one administration of the same drug beyond a 30-minute interval. Report this service using add-on code 90776.

Based on the example above for IV push, if each dose of the Lasix is prepared individually and administered, the first dose should qualify for code 90774. If the second dose is prepared individually and administered, consider the time factor between the first and second administrations before you assign code 90776. If you meet all three of these factors, then the second dose should qualify for code 90776.

The same guidance applies to the administration of Ativan. The first dose qualifies for 90775 (different drug) during this event. Determine how you should report 90776 based on whether the remaining Ativan pushes are prepared individually, administered in total, or administered in portions. Also, consider the time factor requirement.

Yes, this is a complicated process, however, we encourage you to speak with your pharmacy and department to determine how pushes are prepared for your facility and develop a policy and procedure to that effect. Unfortunately, medical record documentation by the clinicians' does not easily allow a coder to determine whether the pushes were individually prepared or administered in portions.

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