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Q. On our new superbill, there is a spot to code for Phenergan (generic is promethazine HCI) 50 mg when administered intramuscularly. How would we code for Phenergan when the physician orders Phenergan 25 mg IM? Do we mark the code x ½?

Anonymous, Illinois
A. If you administer 50 mg of promethazine or any portion of 50 mg, then you use code J2550 (injection, promethazine HCI, up to 50 mg).
For example:

  • 25 mg = J2550
  • 50 mg = J2550
  • 70 mg = J2550 x 2
  • 100 mg = J2550 x 2

This is a general rule for HCPCS medication codes, i.e., you use the code for the amount listed or for any fraction of the amount listed.

Of course, you should also code for the administration code for Therapeutic IM Injection (96372).
Note: For 2009, all therapeutic, prophylactic, and diagnostic injection and infusion codes have been changes to place them in a new code range (96360 – 96379). In the example noted above, the CPT code 90772 for Therapeutic IM Injection has been eliminated and replaced with the new code 96372.

Q. I understand that you can code a new patient E/M every three years. Do you know of a system that will track when the last new patient visit was coded, so that we can make sure that we code a new patient E/M when it has been three years since the last new patient E/M code?

Anonymous, Florida

A. This is another confusion that persists about new vs established patient E/M codes.
No, you do not code a new patient visit every three years. Rather, you should code a new patient E/M (99201 – 99205) if and when the patient is being seen in your urgent care, and the patient has not received face-to-face provider services from a provider (of the same specialty) in your urgent care at any time during the past three years.

If the patient has received face-to-face services from a provider in your urgent care at any time during the past three years, then you should use an established patient E/M code (99212 – 99215).
Visits where the patient does not receive face-to-face services from a provider may include influenza vaccinations, drug screens, and blood pressure checks.

These visits do not count as face-to-face encounters, and should not be considered when applying the three-year rule. Figure 1 (page 44) should help to illustrate this principle.

Q. The doctor obtained a biopsy specimen of a suspicious nevus by shaving the lesion. Should I use a code for lesion removal by shaving or should I use a biopsy code?

Anonymous, California
A. The question to ask first is this, “Why did the doctor remove the lesion?” Was it to obtain a biopsy specimen for microscopic evaluation by a pathologist, or was it to simply excise the lesion from the patient’s skin?
In the case you mention, the lesion was “suspicious” for malignancy, so the biopsy code (11100) – 11101) should be used.

On the other hand, if the lesion was removed via shaving for cosmetic or comfort reasons, then you should code with a code for removal of a lesion by shaving (11300 – 11313).
Note: CPT codes, descriptions, and other data only are copyright 2007 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).

Disclaimer: JUCM and the author provide this information for educational purposes only. The reader should not make any application of this information without consulting with the particular payors in questions and/or obtaining appropriate legal advice.

Medication Supplies, New Patient E/M, and Skin Shaving Vs. Skin Biopsy