What are Administration Codes?
The procedure codes to administer a substance into the body can be found in many section of the CPT® Manual. When billing for Injections, you will also bill for the drug administered found in your HCPCS® Manual maintained by CMS®.
There are several things you need to know when choosing the correct administration code and we will discuss that next.
Route of Administration
This refers to the where you are injecting the patient. The following routes are examples of administration :
- Intramuscular-Administration within a muscle. (96372)
- Intralesional-Administration within or introduced directly into a localized lesion.(11900)
- Intraarticular-Administration within a joint (20610)
- Subcutaneous-Administration beneath the skin; hypodermic. (96372)
- Percutaneous-Administration through the skin. (Many examples)
Type of Substance
The description of some administration codes will also identify many times the type of substance and the goal or effect the care provider wants to achieve for the patient such as in 96372, which identifies that it can be used for the following purpose if done subcutaneous or intramuscular.
Additional code options exist for other routes of administration such as:
96374-intravenous push, single or initial substance/drug
Many administration codes are diagnosis dependent and require a careful eye on the full description of the CPT® Code for selection based on many factors, which include the reason for the injection to justify medical necessity. Medical necessity drives the bus in proper reimbursement, so it will also necessitate a good understanding of Insurance coverage policies to properly link the most specific ICD10-CM code with the correct Administration code.
Look at these examples:
- 60300 Aspiration and/or injection, thyroid cyst
This requires a knowledge that the code includes two options for when they either perform an aspiration and/or an injection. This means 60300 can be used for either or both. It is also important to notice the medical necessity is also part of the code when it mentions “thyroid cyst”. Even if the insurance does not have a coverage policy, the medical necessity of it being performed for a thyroid cyst is concluded by the description and another diagnosis being used may cause a denial or rejection.
- 11900-Injection, intralesional; up to and including 7 lesions
- 11901-Injection, intralesional; more than 7 lesions
These two codes are specific to injecting a substance directly into a lesion. Knowing the difference in a lesion versus other types of conditions will be important. Examples of typical lesions it will be performed for are viral warts and chalazion of the eye.
- 20605-Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
- 20606-Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting
- 20610-Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, sub acromial bursa); without ultrasound guidance
- 20611-Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, sub acromial bursa); with ultrasound guidance, with permanent recording and reporting
In the codes above we see more information that comes into the mix. We can identify that these codes can be used for multiple reasons such as an Arthrocentesis, aspiration and/or injection. Again we follow the thought that either, or and maybe multiple will be done. We are also seeing that have other pieces of data that are important such as the location and if ultrasound guidance was used.
Your CPT® manual will identify if you can bill guidance with certain codes in the parenthetical notes. In the case with 20606 and 20611 for example, they include US Guidance, so you will not be able to report it separately. You are however provided with a crosswalk of other guidance codes in the radiology section that you can report separately such as (77002-Fluoroscopic, 77012-CT, 77021-MRI).
Your site is also very important with these codes, as you will need to know if you are injecting a Small, Intermediate or Large joint. The code descriptors help you here as well, so you can be as specific as possible. Reading codes thoroughly will ensue you code and bill for the most accurate picture of what was done, ensuring you link the appropriate ICD10-CM codes as well for medical necessity.
Billing Multiple Injections
As noted above there are many options for billing various types of Injections. If you work for an Orthopedic Physician, you no doubt will have times when you bill for multiple injections. Although insurance claim processing manuals may differ in how they want claims reported, I will show you an example of how you can report joint injections done on multiple joints:
Check with payers on how to submit:
*These are examples of how some insurance payers have requested claims submitted
One line item with modifier 50
Two line items with modifier 50 on the second code
Example: 20610 20610-50
Two lines using RT/LT
Example: 20610-RT 20610-LT
As always we would want to follow each payer guideline on submission. If for example you inject a Right Shoulder with Depomedrol 40 mg for Primary Osteoarthritis and a Left Knee with the same medication and dosage for knee pain you could expect to possibly report as follows:
CPT®:20610-RT Injection Right Shoulder
ICD10-CM: M19.011 Primary osteoarthritis, right shoulder
CPT®: 20610-LT Injection Left Knee
ICD10-CM: M25.562 Pain in left knee
I hope these examples and identification of all the moving pieces in selecting an administration code are helpful. For more instruction and any of our specialty specific auditing services, please email Jmcnamara@oncospark.com
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