Wiki 99211 with 96372 and J10180

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april.king

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Austin, TX
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I am having a claim reject because of an invalid CPT code for UHC. I am thinking that the nurse visit should not have been billed but wanted to double check.

The patient came in and had the Testosterone administered (brought there own) and the nurse gave the injection.

99211 25
J10180
96372

253.4
 
Because the patient brought in their own medication, you cannot bill the full price for the J code. My office places one cent on the J code charge line and in field 19 we state "pt brought in meds". CPT 99211 can only be billed in certain scenarios. This is not one of them. There is a great article explaining this indetail on www.wpsmedicare.com. CLick on your jurisdiction and then search using CPT 99211.
 
April
Some payers have a hard time with 0 charge item which is why you are allowed to use the .01 charge and then adjust it off. However Teresa is correct there should not be a 99211 charged. When a patient presents for the purpose of a planned injection, you cannot meet the criteria for the use of the 25 modifier, therefore you may bill only the injection and the drug.
 
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