Wiki CPT code for Injections When patients bring their own meds

[cjamieson@me.com]

Hey guys! My practice has been using 96372 for b12 injections when patients bring their own meds. Recently we have been getting denials for "lacking a required modifier" when we have more than one injection. Usually they have a vaccination and also an injection of their own meds. Our office visits have the proper modifiers, what am I missing? Do we need a modifier on one of the injections? One rep said we needed to file it as a vaccine, which sounds like a stretch. Please help!

 

[valleycoder]

Are you with Trailblazers? If so, you now have to bill with a KX modifier on the admin code. i'll post the notice below.

Through the medical review of various infusion drugs, TrailBlazer identified two problems:
•Billing incorrect quantities of the drug administered.
•Billing chemotherapy administration codes inappropriately.

As a result of these findings, the Medical Review department implemented audits to suspend claims for specific drugs to determine if the quantity and administration codes are billed correctly. While reviewing these claims, TrailBlazer has also found that in some cases administration codes are billed without a corresponding drug on the same date of service.

Drug administration billed without a corresponding drug will result in a denial of the administration code. An example seen during the review was patients purchasing a drug and bringing it to the physician's office for the drug to be administered by the physician's staff. In this situation, the physician should:
•Bill the HCPCS code for the drug administered with the correct quantity (according to the dose per unit specified in HCPCS) and a zero charge.
•Append the KX modifier to the administration code.

 

[dballard2004]

Dawnwelle,

Can you please post a link to this info on the Trailblazer site? I have searched their site and I am unable to locate this info. I have clinics that fall under the Trailblazer jurisdiction and I don't think we were informed of this.

Would this guidance also apply to allergy injections if the patient supplies the extract?

Thanks for the info.

 

[eadun2000]

In my experience, you need to add a mod 59 to the IM injection when performed on the same date as a vaccine. Just my two cents

 

[valleycoder]

here's the link:


http://www.trailblazerhealth.com/Tools/Notices.aspx?ID=14067&DomainID=1

Hope this helps!

 

[judy appelman]

CPT code for allergy injection

If a patient comes in for allergy injections and brings their own meds along, what CPT code do you use for administration?
Thanks!
Judy A