PEBS

January 7, 2009

As of 01/01/2009 procedure code 90772 has been deleted and replaced with procedure code 96372. What is important to know is that the new code (96372) should not be reported for injections given without direct physician supervision. If there is no other E/M code (e.g. office visit) reported on that day and an injection is given without direct physician supervision, report a 99211. If there is already an E/M code reported on that day an injection is given without direct physician supervision, then it is not billable separate from the E/M code and is included.

Code Description:

CPT Code: 96372 Quarter: Jan - March 2009

Description: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or

intramuscular

Lay Description: The physician or an assistant under direct physician supervision administers a therapeutic, prophylactic,

or diagnostic substance by subcutaneous or intramuscular injection (96372), intra-arterial injection(96373), or by push into an intravenous catheter or intravascular access device (96374 for a single orinitial substance, 96375 for each additional sequential IV push of a new substance, and 96376 for eachadditional sequential IV push of the same substance after 30 minutes have elapsed). The push techniqueinvolves an infusion of less than 15 minutes. Code 96376 may be reported only by facilities.

CMS Modifiers: Ingenix Modifiers:

Not Applicable Not Applicable

Section Notes/Annotations:

Section Notes - 96372-96379 Injections: Diagnostic/Preventive/Therapeutic - (96372-96379)

Injections: Diagnostic/Preventive/Therapeutic

INCLUDES: administration of fluid

administration of substances/drugs

coding heirarchy rules for facility reporting:

- chemotherapy services are primary to diagnostic, prophylactic, and therapeutic services

- infusions are primary to pushes

- pushes are primary to injections

constant presence of health care professional administering the substance/drug

direct physician supervision:

- consent

- direction of personnel

- patient assessment

- safety oversight

- supervision of personnel

infusion of 15 minutes or less

the following if done to facilitate the injection/infusion:

- flush at the end of infusion

- indwelling IV, subcutaneous catheter/port access

- local anesthesia

- start of IV

- supplies/tubing/syringes

training to assess patient and monitor vital signs

training to prepare/dose/dispose

treatment plan verification

EXCLUDES: catheter/port declotting (36593)

significant separately identifiable evaluation and management service if performed

Code also drugs/materials

Do not report with codes for which IV push or infusion is an integral part of the procedure

January 1, 2009

G0317 changed to 90960 - Endstage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face physician visits per month.

G0318 changed to 90961 - Endstage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2 to 3 face-to-face physician visits per month.

G0319 changed to 90962 - Endstage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 1 face-to-face physician visit per month

Please click on the following link for the RPA published crosswalk for the new outpatient dialysis services http://www.renalmd.org/documents/revisedNEWCPTCODE.pdf.