Outpatient Facility Coding Alert - 2015 Issue 20
Injections: 3 Tips Lead You to Antibiotic Injection Pay
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Article Overview
This article reviews Medicare-related coding considerations for an in-office antibiotic injection scenario. It is aimed at coding and billing professionals who need to understand the general categories of reporting involved for the injection administration, the drug supply, and the associated evaluation and management service, along with related claim documentation and edit considerations.
Why This Topic Matters
It helps billers and coders recognize that an in-office antibiotic injection encounter may involve more than one reportable service, which can affect whether all components are captured on the claim.
Article Sections
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Overview of the antibiotic injection scenario
Introduces the common office-based situation addressed in the article and frames the billing components that may be involved. It also references Medicare coverage in a general way.
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Reporting the injection administration
Discusses the administration component of an office-based antibiotic shot and the general type of service this relates to. It places the focus on the injection encounter rather than the drug supply.
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Charging the drug supply per unit
Covers the drug supply portion of the encounter and general claim presentation issues that may arise when units are involved. It also addresses payer handling and appeal considerations at a high level.
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Billing the evaluation and management service
Explains that the visit may also involve an office evaluation and management service tied to the clinical decision to administer the injection. It includes general discussion of visit level selection and claim-edit considerations.
What You Will Learn
- How an office-administered antibiotic injection encounter may be broken into separate billing components
- What general billing areas are involved for the administration, drug supply, and related visit
- How payer processing and claim-edit issues can affect reporting of the encounter
- What kinds of documentation themes may support reporting the associated services
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice administrators
- Physician office staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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