Internal Medicine Coding Alert

Published on Tue Apr 14, 2009 PDF

Question: The physician I work for has the nurse routinely give shots such as Rocephin, Toradol and so on as needed. How do I bill for those injections?

Montana Subscriber

Answer: Charge 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the administration of the drugsprovided the procedure is eligible for separate payment.

Report the appropriate J code for the drug provided your office paid for the supply. Pay close attention to the dosage, as some drugs may be per 250 mg, for example,and if the patient is given 500mg, you will charge for two units. Rocephin is found under J0696 (Injection, ceftriaxone sodium, per 250 mg), and Toradol is found under J1885 (Injection, ketorolac tromethamine, per 15 mg).

CCI 15.0 bundles 96372 into all office visit codes (99201-99215). A modifier, such as 25, can break all edits except for 96372 and 99211.

Example: Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) is billed with an injection service. Pay only for code 99211 and the separately payable drug.