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Coding FAQs: Injection/Infusion

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1. Can an MD bill “incident to” Remicade infusion when “immediately available” only, in addition to nurse time 96413?
A: “Incident to” services are billed as if the physician provided the service so the nursing time in the infusion would be billed appropriately if the physician is immediately available.

2. How should I properly code for infusions, e.g., Remicade? When does the time start and end? How do I code time of other than one-hour increments, e.g., how would I code central infusion time of 2 hours, 37 minutes?
A: Code only for time spent actually infusing the patient. Use 96413 for the first hour and 96415 for each additional hour (e.g. 2 hr. 37 min is 96413, 96415 x 2)

3. What is the ICD-9 code for “trigger point”?
A: There is no one ICD-9 code for “trigger point,” as these can be done for many reasons.

4. What are the new codes for trigger point injections and how do I bill for them?
A: There are two new codes that can be used for trigger point injections.
20552 – Injection (s); single or multiple trigger point (s), one or two muscle(s).
20553 – Injection (s); single or multiple trigger point (s), three or more muscle(s).
These codes are per session codes not per injection codes. Therefore, you would bill one time only per session for one or more injections depending on the number of muscle(s) involved.

5. Can I bill multiple trigger point codes using a modifier?
A: No, the new codes by definition describe a per session charge. You should count the number of muscle(s) injected and determine which code to select by the number of muscle(s) injected.

6. We have several patients who receive weekly IM Methotrexate injections in our office given by an RN. How should we bill this? (injection and drugs vs. “incident to” service vs. 99211)
A: Injection and drug would be most appropriate in most cases.

7. How do we code for carpel tunnel injection?
A: The CPT code for this procedure is 20526.

8. What is the difference in coding for an injection of a tendon sheath and tendon origin?
A: Injection of tendon sheath would be coded 20550; injection of tendon origin is coded 20551.

9. What diagnostic and injection code should be used for treatment of Sacroiliitis?
A: ICD-9 -720.2-inflammation of sacroiliac joint NOS; CPT –20610.

10. Can a nurse’s visit be billed when patients get infusion treatment?
A: The nursing visit, 99211, cannot not be billed with any drug administration codes; this includes the 96413 and 96415 codes for infusion. The nursing visit is included in the relative value unit for all drug administration codes.

11. When coding for more than one injection/aspiration in a different anatomical site in the same session, how do I code so that each additional injection after the first is paid?
A: If performed bilaterally you would use the modifier -50 with LT/RT. If it is a different anatomical site, then it could be a modifier -59. Modifier -59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate lesion, or separate injury not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate it should be used rather than modifier -59.

Medicare and most carriers apply the multiple surgery rules when paying for multiple injections. They pay 100% for the first procedure, 50% for the second through the fifth procedures and any additional procedures over five requires additional documentation.

It should also be reiterated that the above rules apply to joint or tendon injections and not with trigger points. Trigger points are addressed in the Procedures section #5 and #6.

12. When does the time start for infliximab infusions?
A: The time does not start until the medication is started in the IV. You may not include the prep time of your staff to get the patient ready for the infusions. This is built into the relative value unit of the code.

13. What type of documentation is needed for ultrasound guidance?
A: There has to be documentation of obesity (i.e., what is BMI), description of joint damage or description of patient improvement from having the procedure done with ultrasound guidance.