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Q/A. One injection code or two?

APCs Insider, March 27, 2009

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Q. The CPT Assistant, September 2007, Volume 17, Issue 9, seems to contradict the Q&A from the APCs Weekly Monitor of June 16, 2006. The CPT Assistant says to report CPT code 90772 (now 96372) for two doses of an antibiotic, given at 1:31 and 3:40. The APCs Weekly Monitor Q&A says when a nurse splits a dose of a drug, it should be reported with code 90772 (now 96372) only once. Which one is correct?

A. The APCs Weekly Monitor question and the question from CPT Assistant address two different scenarios. The CPT Assistant Q&A discusses two separate doses of the same medication, the first at 1:31 and the second at 3:40. At the time this question came up, CPT had just changed the definition for IV push injections to be "per drug/substance." This caused some confusion, and many wanted to know if this definition also applied to intramuscular/subcutaneous (IM/SQ) injections. The AMA clarified that two IM/SQ doses of the same drug would be reported individually.

It isn't customary practice to "split" one dose of a medication and administer the injections two hours apart. The time frame cited in CPT Assistant generally confirms that the injection was ordered as two individual doses.

The 2006 APCs Weekly Monitor question has to do with splitting a single dose. This splitting is usually due to one or more of the following:

  • The volume required for the dose exceeds the amount recommended for a single injection
  • The viscosity (thickness) of the medication
  • The substance can be very irritating to the tissue

Here is the original 2006 APCs Weekly Monitor question with an updated answer, incorporating recent information from the CPT Knowledge Base. (The CPT Knowledge Base is affiliated with the American Medical Association.)

Report multiple units of 96372 for a split dose

Q. A physician orders one dose of a medication to be administered IM/SQ. The volume required for this dose exceeds the amount recommended for a single injection, so the nurse must split the dose into two IM/SQ injections. Can we report one or two units of 96372 to report this service?

A. The definition of CPT 96372 states "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular," and represents a single IM/SQ injection. In the case of a "split dose", as described in your question, the drug is prepared and drawn up into two separate syringes. It is then administered in two individual injections in two distinct anatomic sites. Report each injection individually with CPT code 96372. To substantiate the charges, nursing staff should document that the medication was administered in two injections and note the site of each injection.

 



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