Billing 96372

[Elnora2009]

Can 96372 be billed without the J code? For instance if a patient supplied their own medication bought through their pharmacy. We have billed with .01 on the J code but want to clarify if it is needed for payers. Thank you

 

[OpenClaims]

I am getting an edit that the J code must be reported in addition to the 96372. I'm an unsure of the penny charge, because every I see penny charges for something, they are being denied.

Here is an article from AAPC Codify stating that you would only bill for the admin in this case. 96372 Applies If Patient Brings Own Meds : Reader Question

 

[csperoni]

Whether or not you should bill the J code depends on the payor policy. From my experience, Medicare & most carriers want the J code. Basically, they want to ensure the medication being injected would be covered under the policy.
When the patient supplies the meds (like your case), billing the J code with .01 is the right way to go. Even if the carrier doesn't require it, I don't recall it ever being an issue.

 

[rschum]

We bill 96372 when we give testosterone or b12 shots. It hits an edit in our billing system for no j code but we bypass it then it processes just fine with the payers.

 

[mgarcia400]

We give testosterone shots at our practice, patients provide their testosterone. We bill J code with 96372, insurance pays the injection for it.

 

[Tink1970]

This probably a silly question but I am brand new and wondering. Can you bill an E&M code with a 96372 if a psychiatrist is giving the injection?

 

[rschum]

This probably a silly question but I am brand new and wondering. Can you bill an E&M code with a 96372 if a psychiatrist is giving the injection?

You absolutely can, but the caveat is, is it reimbursable with the E&M? If the patient is just coming in for the injection then no, it wouldn't be reimbursable because it's not separately identifiable from the E&M. If the patient was receiving counseling or something along those lines and then also received an injection then that may be separately identifiable from the E&M, so you'd want to add the modifier 25 to the E&M. Some payers still bundle 96372 and the E&M together even with the modifier 25, and some payers want a different diagnosis between the 2 CPT codes. Hope this helps!