Health Information Management

Q&A: Billing CPT code 92977 for professional charge

JustCoding News: Outpatient, December 30, 2009

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QUESTION: I have a question about CPT® code 92977 (Thrombolysis coronary; by intravenous infusion). We billed CPT code 92977 to Medicare as a professional charge along with CPT code 99285 (Emergency department visit) with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Medicare denied CPT code 92977, stating there should be a modifier. Do you know whether this code needs a modifier when billed as a professional charge?

ANSWER: Code 92977 reports the provision of the infusion when performed by the physician, which is uncommon. Typically a nurse performs the infusion. So Medicare may be looking for a modifier such as -TD to indicate that the registered nurse actually provided the service, and not the physician.

Because it is highly unusual for an ER physician to perform an infusion, Medicare might be expecting to see a modifier such as -TD. However, if the physician actually provided the infusion, then resubmit the claim with documentation. If the physician ordered it but a nurse actually handled the service, then I suggest finding the correct personnel modifier (e.g., -TD for RN, -TE for LPN) and append it to the infusion code.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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