Wiki 96372 denials

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jmeberst314@gmail.com

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I have been received multiple denials from Medicare when I bill a claim with just 96372 and a J-code or even 96372 on its own. Has anyone else had these problems and do you know how to fix it? Any help would be appreciated. Thanks!
 
As Suzanne said, details would help, but in general (assuming it is not among the non-covered issues), I have seen carriers requiring either the NDC with the J code, or if there is no J code (patient brought injection to the office) then we have to enter a details in a field in our software that then puts detail in the electronic claim "field" that ID's for the carrier what the injected drug was - even though we don't bill for the drug itself. I assume you've called the carrier?
 
Same issue with e/m and injections

Up until 2 weeks ago we have been paid for the e/m and injections (j1885 and j3420). Suddenly we are only being paid for the 96372. I have the ndc info included on the claims and I've contacted medicaid only to be told that they can only say the e/m is incidental and can't tell me how to rebill it..... Any tips would be appreciated!
 
Falison75 said:
Up until 2 weeks ago we have been paid for the e/m and injections (j1885 and j3420). Suddenly we are only being paid for the 96372. I have the ndc info included on the claims and I've contacted medicaid only to be told that they can only say the e/m is incidental and can't tell me how to rebill it..... Any tips would be appreciated!
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Again details here are important. What was the dx code?, what was the visit level? did you append a 25 modifier?
 
Yes the denials are associated with vitamin b-12 deficiency. I will just submit a claim for 96372 and j3420 with dx 266.2 because the patient comes in for just an injection we do not bill for an office visit. Also sometimes the patients actually bring in the medication with them so I just bill for the 96372. These are the denial codes/reasons that I have been given 151: the info submitted does not support this many frequency & B15: The procedure requires that a qualifying service be received and covered. Whenever I call them they provide me with the denial reason and suggest that I go to their site for additional information.
 
Medicare does not cover most B12 injections and those that they do cover are for a limited number. You should have had the patient sign an ABN. Medicare by and large have deemed B-12 to be a self administered medication. when you bill the 96372 you need a J code to go with it so you append a .01 charge for the times the patient brings in the medication. Then if Medicare does not cover the medication they will deny the administration.
 
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