B12 injection in the office

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B12 given in the office by the NURSE

I understand from CPT that 96372 is to be used when there is "direct physician supervision". Otherwise 99211 is to be used. So when the B12 is given by the nurse, without the MD present in the room, I don't think 96372 is the right choice. But 99211 is an E/M code, and when only an injection is given, that doesn't qualify as an E/M in my opinion.

Am I misunderstanding "direct physician supervision"?
 

audioles

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I'm stuck on...if B12 is now on the Self-Administered Exclusion List for our carrier, does it require supervision if administered in the office (despite the fact that the patient will be responsible for payment)?
 

mitchellde

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I understand from CPT that 96372 is to be used when there is "direct physician supervision". Otherwise 99211 is to be used. So when the B12 is given by the nurse, without the MD present in the room, I don't think 96372 is the right choice. But 99211 is an E/M code, and when only an injection is given, that doesn't qualify as an E/M in my opinion.

Am I misunderstanding "direct physician supervision"?
Direct physician supervision means the physician is in the immediate office suite area, over the shoulder supervision means the physician is in the room with the nurse.
 

Brendalm

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b-12

I know this is an old post, but how would you code b-12 injection given by nurse when Dr. is not on the premises.

Thanks,
Brenda
 

mitchellde

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Freebee! To code a 99211 for a nurse encounter the physician must be within the immediate office suite area. I do not know why the AMA code book states to use the 99211.
 

mitchellde

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CMS reversed their guideline on this in 06, prior to that it was a CMS guideline to include the injection with the OV. Go to the transmittals section of the CMS website and look in 2006 for a transmittal on injections and ov with the 25 modifier. you do have to use modifer 25 on the OV.
 

Brendalm

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b-12

Just starting a billilng company, so I don't have a client yet, but a relative went to physicians office, for a b-12 shot only, given by the nurse, no physician was in the office and they submitted codes
99212
96372
J3420
G8446 and Medicare approved all except the G code. I hope this helps you.
My issue is I know this was submitted wrong. But I was hoping to know the correct way to charge a nurse visit with b-12 injection only, given by the nurse and no physician on the premises. If anyone would like to give an opinion I would greatly appreciate it.

Thanks, Brenda
 

mitchellde

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There is no way to charge for nurse services if there is no physician or Nurse practioner on site to supervise and then whoever is supervising to bill under.
 

Walker22

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Patient received B12 shot only, with no full ofice visit done. The injection was given by a NP with no physician directly supervising. You would code 99211.
 

Brendalm

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Debra, I looked up the CMS 2006 transmittal for more clarification. Thank you for the info. I posted it here for others that may be confused.

The CPT 2006 includes a parenthetical remark immediately following CPT code 90772 (Therapeutic, prophylactic or diagnostic injection; (specify substance or drug); subcutaneous or intramuscular.) It states, “Do not report 90772 for injections given without direct supervision. To report, use 99211.”

This coding guideline does not apply to Medicare patients. If the RN, LPN or other auxiliary personnel furnishes the injection in the office and the physician is not present in the office to meet the supervision requirement, which is one of the requirements for coverage of an incident to service, then the injection is not covered. The physician would also not report 99211 as this would not be covered as an incident to service.

Brenda
 
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I am having the same issue getting injections paid. However, in my opinion for your case...I would question if there really is a significant and seperately identifiable E/M code. If this is a scheduled B12 shot, and thats specifically what the pt was scheduled for, I'm curious as to what E/M you would bill. I'm in Urgent Care and we often bill for therapeutic injections (pain management), and I have SUDDENLY gotten a ton of rejections for this code from BS (the ONLY insurance stating this) that it is inclusive. I have been back and forth with 2 different BS reps, mailed appeals..and have gotten nowhere!!! I'm interested in the fact you received a response that it was due to CMS guidelines. I have never even received that much of a response! My theory is that this is a claims software issue with incorrect edits, but trying to get anyone that has a clue there to research it is easier said then done. Any help would be appreciated!!
 

mitchellde

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Patient received B12 shot only, with no full ofice visit done. The injection was given by a NP with no physician directly supervising. You would code 99211.

An NP does not need a physician to perform injections and should bill a 96372 for any injection but you will need to bill under the NP number not the physician if the physician is not on site.
 

Brendalm

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I am having the same issue getting injections paid. However, in my opinion for your case...I would question if there really is a significant and seperately identifiable E/M code. If this is a scheduled B12 shot, and thats specifically what the pt was scheduled for, I'm curious as to what E/M you would bill. I'm in Urgent Care and we often bill for therapeutic injections (pain management), and I have SUDDENLY gotten a ton of rejections for this code from BS (the ONLY insurance stating this) that it is inclusive. I have been back and forth with 2 different BS reps, mailed appeals..and have gotten nowhere!!! I'm interested in the fact you received a response that it was due to CMS guidelines. I have never even received that much of a response! My theory is that this is a claims software issue with incorrect edits, but trying to get anyone that has a clue there to research it is easier said then done. Any help would be appreciated!!

CMS paid for 96372 & J3420 with 99212, the issue with this was there was no physician or NP in the building. This isn't a client, I discovered it when reviewing a relataives EOB.

Brenda
 

mitchellde

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CMS paid for 96372 & J3420 with 99212, the issue with this was there was no physician or NP in the building. This isn't a client, I discovered it when reviewing a relataives EOB.

Brenda
CMS has no idea there was no provider around for this encounter. It was billed I am sure using the physician NPI. Under no circumstance can a 99212 be charged if there is no provider face to face with the patient. I would have the relative request a copy of the documentation and then contact CMS for a review.
 

hthompson

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It has been my understanding that as long as a physician ordered something for a patient and there is documentation in the chart of that, ie shot of B12 or methotrexate for a diagnosed condition that is being followed by the MD, that it is perfectly acceptable for the nurse to give the injection and charge 99211 with the injection J code even if the MD is not present. If the MD was not in the room, but was available in the facility, you would use 96372 instead of 99211. Please show me documentation that disagrees with this if I am understanding this incorrectly.

96372 below states: (Physicians do not report 96372 for injections given without direct physician supervision. To report, use 99211. Hospitals may report 96372 when the physician is not present)

Also in the back of my current CPT book are examples for a 99211:

Office visit for a 69-year-old female, established patient, for partial removal of antibiotic gauze from an infected wound site. (Plastic Surgery)

Office visit for an 82-year-old female, established patient, for a monthly B12 injection with documented Vitamin B12 deficiency. (Geriatrics/Internal Medicine/Family Medicine)

Office visit for a 50-year-old female, established patient, seen for her gold injection by the nurse. (Rheumatology)

Office visit for a 45-year-old male, established patient, with chronic renal failure for the administration of erythropoietin. (Nephrology)

Office visit for a 42-year-old, established patient, to read tuberculin test results. (Allergy & Immunology)

Office visit for 14-year-old, established patient, to re-dress an abrasion. (Orthopaedic Surgery)

Office visit for a 23-year-old, established patient, for instruction in use of peak flow meter. (Allergy & Immunology)

Office visit for prescription refill for a 35-year-old female, established patient, with schizophrenia who is stable but has run out of neuroleptic and is scheduled to be seen in a week. (Psychiatry)

Office visit for a 9-year-old, established patient, successfully treated for impetigo, requiring release to return to school. (Dermatology/Pediatrics)

Office visit for an established patient requesting a return-to-work certificate for resolving contact dermatitis. (Dermatology)

Office visit for an established patient who is performing glucose monitoring and wants to check accuracy of machine with lab blood glucose by technician who checks accuracy and function of patient machine. (Endocrinology)

Outpatient visit with 19-year-old male, established patient, for supervised drug screen. (Addiction Medicine)

Office visit with 31-year-old female, established patient, for return to work certificate. (Anesthesiology)

Office visit for a 45-year-old female, established patient, for a blood pressure check. (Obstetrics & Gynecology)
 

mitchellde

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If you are billing a place of service 11 then you may not use the physician NPI if that physician is not present in the office while the patient is being seen. The nurse is an employee of the physician and can perform any task dictated to her that falls within the scope of her practice as long as the physician is on site. I do not know why the AMA book says what it says but you cannot charge a 99211 to give an injection and you may not charge a 99211 for a nurse encounter if the physician is not onsite if you are a physician office.
 

Brendalm

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B12

I understand CMS would not know about no physician on the premisis. I was just giving Jenny an example of what codes were used to get paid for b-12 injection by CMS.
Thank you all for your input and I do get 99212 now. :)

Thanks again,
Brenda
 

jsa1517

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the correct codes to use for B12 are as most others said :

96372 ther/diag inj &
j3420 is the B12
 

renee.lyle

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Units J3420

I have a question regarding units for the J3420. I have seen Medicare pay on 2 units but most of the time Medicare denies the 2 to 3 units as CO-151. Is there some rule of thumb to go by? Any input would be greatly appreciated.
 

JWESS

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Medicare no longer pays for the j3420 as they deem it a med the patient should be able to give themselves so the 96372 is still payable but the j3420 will be denied pt liability
 

caramella025

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If you had an office visit along with the injection you're going to need modifier 25 on the e/m to show it's a separately identifiable service. If there was a substantiated office visit in addition to the injection.



BS denied the admin 96372 portion for a B12 inj stating it is inclusive in the E/M visit of the same day, claiming it to be a CMS guideline. Can anyone comment on that?
 
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sls314

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Hi, where can I find the fee schedule for 2022 CPT prices for VIT D and administration charges? thank you

For what payer?

You can find Medicare rates on the CMS website. Here's a link to the CMS physician fee schedule search tool: https://www.cms.gov/medicare/physician-fee-schedule/search

You can find Medicaid rates on the state's Medicaid website.

For commercial payers, you'll need to refer to your provider contract to determine your contracted fee schedule.
 
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