Wiki 96372 (again) for self-pays

[g.fairchild]

Hi. Somewhere my Administrator has the idea in his head that for self-pay patients we are not "allowed" to bill the injection administration fee for a Toradol injection (only the drugs). I had never heard of this. I do know that we usually do not charge the office visit, unless there is something separately identifiable within the visit. Has anyone ever heard of this? I think we are leaving money on the table. Thanks.

 

[armen]

Hi. Somewhere my Administrator has the idea in his head that for self-pay patients we are not "allowed" to bill the injection administration fee for a Toradol injection (only the drugs). I had never heard of this. I do know that we usually do not charge the office visit, unless there is something separately identifiable within the visit. Has anyone ever heard of this? I think we are leaving money on the table. Thanks.

The "allowed" and "not allowed" has nothing to do with self pay or any other insurance. You need to code based on notes and coding guidelines. If this is a pre planed procedure, then you just bill injection + drug, if not, and separately identifiable - off visite + injection + drug. that is what we do in case of Supartz injection. Maybe this is an internal policy for self-pay patient (kind of discount).
96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

 

[g.fairchild]

Thanks for the response, and yes I agree with you that we should be billing the admin. As far as I know there is no internal policy that we should not...so I don't know where this is coming from....