Revenue Cycle Insider

Question: Our office administers patient-supplied intramuscular medications. Can we report CPT^® 96372 for the injection administration even if we don’t provide or supply the medication?

Codify Subscriber

Answer: If the patient’s payer allows separate payment, and the documentation of the encounter supports medical necessity, coders should report only 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) when your practice performs a qualifying subcutaneous or intramuscular injection, even if the medication is supplied by the patient or is otherwise not billable by your practice.

Code 96372 describes the administration service rather than the drug supply; coders should not report a HCPCS Level II drug code if their practice did not incur the medication cost and is not billing for the drug. Some payers require claim notes identifying the medication as patient-supplied, along with the drug name and dose, so make sure to verify payer-specific instructions before submitting the claim.

For audit support, the record should identify the medication or substance administered, dosage, route, injection site, date, ordering provider, medical necessity, and the staff member who administered the injection. If the injection occurs on the same date as an evaluation and management (E/M) service, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code — but only if the documentation supports a significant, separately identifiable E/M service beyond the work normally included in giving the injection.

Example: A patient brings prescribed testosterone cypionate to the office. The nurse administers 1 mL IM in the right gluteal muscle under the provider’s order. The record lists the medication, dose, route, site, and therapeutic reason. Because the practice administered but did not supply the medication, the claim may include 96372 only; do not report the testosterone supply code.

Remember: Do not use 96372 for vaccine administration, IV push/infusion services, injections bundled into another procedure, or a nurse-only encounter that lacks a separately reportable service. Also, avoid adding a drug code without a cost charge unless the payer specifically instructs you to do so.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC