CPT Code 96372

TYSON1234

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Is anybody else having problems billing 96372????? This has always been a payable code, but now Cigna and HAP are denying this code. Any input would be appreciated.

Thank you!!!
 

TYSON1234

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No, their denials state this procedure code is disallowed because the related primary service wasn't billed or denied. I called both insurance companies and they told me to bill a 99211/99212 with the code. I told them "NO", because they're only coming in for injection only.
 

TYSON1234

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I have always billed the injection fee only. I looked on their websites to see if they had something posted and couldn't find anything. I guess I can try to add the injection on the claim with $0.01 and see what happens.
 
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Hi,
I was curious to see what your results were with billing 96372 with the drug for .01.
Thank you
 

ellzeycoding

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Why aren't you billing for the cost of the drug with a j-code? Or is it patient provided? If it's patient provided, then bill it with $0.01 as stated above!
 

TYSON1234

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Pt brought her own medicine, we do not provide it for the patient. The denial code was " This procedure code is disallowed because the related primary service wasn't billed or denied."
 

scuatro4

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Is anybody else having problems billing 96372????? This has always been a payable code, but now Cigna and HAP are denying this code. Any input would be appreciated.

Thank you!!!

In the CPT book "Do not report 96372 for injections given without direct physician or other qualified health care professional supervision. To report, use 99211. Hospitals may report 96372 when the physician or other qualified health care professional is not present"

Im reading this and what Im understanding if Im not mistaken is that is only hospitals may use 96372. But for office setting only 99211 can be used, because 96372 is bundled with 99211. I also looked into the CCI edits and it shows (0) on 99211, Indicates that there are no circumstances in which a modifier would be appropriate.

But i would also like clarification why it is being bundled...
 

mitchellde

True Blue
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You can use 96372 in the office setting, you just must have a physician or NP in the office at the time of the service, you cannot use a 99211 when the reason for the encounter is to give an injection.
 
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Question along the same lines with the injection. We're debating if an antibiotic injection can be charged when given as a precaution against infection prior to a planned procedure done in the office. I was taught that when done as a prophylactic with a procedure that it is bundled, but now can't find anything in writing to support this. I know Blue Cross has rejected the ones the office tried to bill out as bundled with the procedure, but is this the hard and fast rule across the board?
 
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