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Wiki 99215,96372,96372, j2550, j0282
- Thread starter nelstx2
- Start date
OCD_coder
True Blue
I bill this combination all the time for our migraine patients.
E&M-25
96372 x 2 units ** NO MODIFIER 59 ** linked to Dx 1, 2
Drug #1 - linked to Dx 1
Drug #2 - linked to Dx 2
I have never gotten a denial in 3 years from any carrier reporting this code combination this way.
As a coder you think different sites of administration and it would be appropriate to use a modifier 59 and by CPT rules it is. A laterality modifier does not typically (does not mean never) apply to integumentary codes (this is a medicine code so think outside of the box) and the denial may come in stating "inappropriate modifier used" with LT/RT. But the carriers don't seem to program the computers for this CPT code to accept it easily, possibly because it has to do with it [96372] being a Medicine code.
Note: Never bill a 99211 with a 96372 as a modifier is not allow to override the NCCI edit.
E&M-25
96372 x 2 units ** NO MODIFIER 59 ** linked to Dx 1, 2
Drug #1 - linked to Dx 1
Drug #2 - linked to Dx 2
I have never gotten a denial in 3 years from any carrier reporting this code combination this way.
As a coder you think different sites of administration and it would be appropriate to use a modifier 59 and by CPT rules it is. A laterality modifier does not typically (does not mean never) apply to integumentary codes (this is a medicine code so think outside of the box) and the denial may come in stating "inappropriate modifier used" with LT/RT. But the carriers don't seem to program the computers for this CPT code to accept it easily, possibly because it has to do with it [96372] being a Medicine code.
Note: Never bill a 99211 with a 96372 as a modifier is not allow to override the NCCI edit.
Last edited:
mitchellde
True Blue
The Current Procedural Terminology (CPT) manual clearly states that the 96523 code should not be billed if an injection or infusion is provided on the same day. That code is used for a port flush . You bill just the Injection administration code for the route that was used, if it is IM use the 96372.