Wiki 96372 Therapeutic injections during office visit

[mebjones83]

I have a claim that has an office visit (99213) with a therapeutic injection (96372) and J3301 (Kenalog). Looking at CCI edits, it states that it's inappropriate to bill 99213 with 96372. I've also noticed that insurance has rejected this before, (with 25 mod. on 99213). If I bill 99213 and J3301 and leave off the injection, would I still put modifier 25 on the office code to account for J3301 (kenalog)? I can't remember. Thank you!

 

[cnjacobs15]

I have a claim that has an office visit (99213) with a therapeutic injection (96372) and J3301 (Kenalog). Looking at CCI edits, it states that it's inappropriate to bill 99213 with 96372. I've also noticed that insurance has rejected this before, (with 25 mod. on 99213). If I bill 99213 and J3301 and leave off the injection, would I still put modifier 25 on the office code to account for J3301 (kenalog)? I can't remember. Thank you!

If the provider truly providers e&m services along with the injection you should bill for both. the NCCI edit is because 96372 requires Direct Physician Supervision. So you have to justify and support that the E&M is not being billed simply for the providers supervision of the injection. I mean if the provider is only billing for the supervision though i would advise them to bill a low level because if the insurance denies it will likely need to be written of CO97..

the issue we have is when the insurance denies the E&M even with mod 25 as CO97 bundling it with the 96372 even if they are being seen for other conditions not related to the injection my most common issue is wit our local highmark and B12s injections. So say the patient is being seen for the following conditions and the provider codes the following ICD-10 HTN (I10) anxiety(F41.1) and B12 deficiency E53.8and happen to be due for their B12 injection. To support the use of modifer 25 since the provider is truly providing additional evaluation and management i bill it as.
992xx - 25 - I10, F41.1, E53.8
96372 - E53.8

regardlesss of the conditions being managed bill for what was done and if the documentaiton supports that the provider provided evaluation and management beyond supervising the injection and the insurance denies i do investigations/appeals to support overiding the NCCI edit with modifier 25 and provide the medical records.

hopefully this makes sense!

 

[rstroup]

I have a claim that has an office visit (99213) with a therapeutic injection (96372) and J3301 (Kenalog). Looking at CCI edits, it states that it's inappropriate to bill 99213 with 96372. I've also noticed that insurance has rejected this before, (with 25 mod. on 99213). If I bill 99213 and J3301 and leave off the injection, would I still put modifier 25 on the office code to account for J3301 (kenalog)? I can't remember. Thank you!

No, however, I'm not sure I understand why you wouldn't want to report 96372 if the injection was administered. You code for the services rendered regardless of what insurance chooses to pay.