Wiki billing a 96372 with E/M

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avrilw

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Newport, WA
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Hi there, I would like to get a second opinion about billing a 96372 with an E/M for the following procedure note. I have another coder stating that it is not appropriate to bill the 96372 for the Toradol injection for the following note due to Medicare NCCI coding policy Chapter 11. I personally believe it should be separately billable. (I only posted the HPI and assessment and plan for the note.)

Any and all advice and suggestions welcome please.

Thank you


Chief Complaint: Toe Redness

History of Present Illness:
Patient,male here for 4 days of third digit right foot pain swelling and inflammation. Progressively worsening. Working its way up the right foot. No known injury. Came on suddenly. Denies any fevers or chills. Denies any history of osteomyelitis, cellulitis or gout.

Review of Systems:
Review of Systems
Constitutional: Negative for chills and fever.
Musculoskeletal: Positive for joint pain.
Skin:
Red swollen third digit right foot
Neurological: Negative for tingling and sensory change.



Assessment & Plan
1. Toe pain, right (Primary)
Comments:
Sent over for urgent x-ray and labs. Concern for questionable osteomyelitis versus gout. Will get labs x-rays and follow-up.
Orders:
- CBC with Differential; Future
- Uric Acid; Future
- sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 mg per tablet; Take 1 tablet by mouth 2 times daily. Dispense: 20 tablet; Refill: 0
- colchicine 0.6 mg tablet; Take 1 tablet by mouth Daily Two tabs po x 1 followed by 1 hour po in 1 hour. Dispense: 3 tablet; Refill: 0
- ketorolac (TORADOL) injection 60 mg
- XR Foot Right 3 + Vw
- C-Reactive Protein; Future
- Sedimentation Rate; Future
 
0
In order to validate Diagnosis, it must MEAT. "orders for xrays and labs and such" is MEAT for "Toe Pain".
Providers could any procedure if providers think medically necessary, with support Documentation.
 
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avrilw said:
Hi there, I would like to get a second opinion about billing a 96372 with an E/M for the following procedure note. I have another coder stating that it is not appropriate to bill the 96372 for the Toradol injection for the following note due to Medicare NCCI coding policy Chapter 11. I personally believe it should be separately billable. (I only posted the HPI and assessment and plan for the note.)

Any and all advice and suggestions welcome please.

Thank you


Chief Complaint: Toe Redness

History of Present Illness:
Patient,male here for 4 days of third digit right foot pain swelling and inflammation. Progressively worsening. Working its way up the right foot. No known injury. Came on suddenly. Denies any fevers or chills. Denies any history of osteomyelitis, cellulitis or gout.

Review of Systems:
Review of Systems
Constitutional: Negative for chills and fever.
Musculoskeletal: Positive for joint pain.
Skin:
Red swollen third digit right foot
Neurological: Negative for tingling and sensory change.



Assessment & Plan
1. Toe pain, right (Primary)
Comments:
Sent over for urgent x-ray and labs. Concern for questionable osteomyelitis versus gout. Will get labs x-rays and follow-up.
Orders:
- CBC with Differential; Future
- Uric Acid; Future
- sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 mg per tablet; Take 1 tablet by mouth 2 times daily. Dispense: 20 tablet; Refill: 0
- colchicine 0.6 mg tablet; Take 1 tablet by mouth Daily Two tabs po x 1 followed by 1 hour po in 1 hour. Dispense: 3 tablet; Refill: 0
- ketorolac (TORADOL) injection 60 mg
- XR Foot Right 3 + Vw
- C-Reactive Protein; Future
- Sedimentation Rate; Future
Click to expand...
I FOUND A NOTE UNDER THE 96372 CODE THAT YOU CAN BILL IT WITH E/M 99211-25 ONLY
 
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