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Don’t confuse 90788 with 90782

You can ethically increase your reimbursement for Rocephin visits if you bill for the procedure, the supply and the E/M service.

With antibiotic injection administration (90788) paying only $16.80 and ceftriaxone sodium (J0696) drug cost reimbursing at $13.35, you can’t afford to lose dollars providing the shot and drug. To avoid omitting any charges, follow three steps:

1. Use 90788 for the Injection

When you or your staff administer a Rocephin injection, you should report 90788 (Intramuscular injection of antibiotic [specify]). Physicians use Rocephin, a type of antibiotic, which you may know by the generic name of ceftriaxone sodium, to treat serious bacterial infections

Even if an insurer doesn’t pay much for 90788, this is the correct code to use. You may mistakenly use 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) as a catchall injection code. But 90782 isn’t for an antibiotic injection. Code 90782 instead describes a therapeutic, prophylactic or diagnostic injection. Translation: Use 90782 for a preventive shot, such as Synagis for respiratory syncytial virus (RSV), or a restorative treatment, like Decadron for croup.The difference between 90782 and 90788 is the injection material.          

Watch out: The only time that you should report 90788 for a Rocephin injection is if your payer instructs you to do so.

2. Charge J0696 Per Unit

Remember that 90782 includes the administration only -- you still need to bill for the supply. You should report the Rocephin with J0696 (Injection, ceftriaxone sodium, per 250 mg) per 250 mg.

Make sure you charge for the dose that you administer. For each 250 mg of Rocephin, you should bill one unit of J0696. List the unit(s) in the units field of the claim form next to the supply code. If you use a partial unit, such as 600 mg, round up to the next unit.

If appeals fail, consider writing a prescription for Rocephin. If you have a nearby pharmacy, the parent can pick up the antibiotic and return to your office for the injection. But sending the parent out to pick up the Rocephin for a very sick child may not be convenient, timely or appropriate.

3. Bill E/M That Represents Level, Time

For the evaluation, history and medical decision-making that lead you to administer the injection, you should report an office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient …). After examining and assessing the child, the physician decides that an antibiotic injection is the best treatment.