Question Depo Injection code change?

sfirth1

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Patient came in for a Depo injection and the pharmacy provided the medication so I filed 96372 with Z30.42. The codes have been paid by all insurance companies all year long until now. Anthem is stating it was "reported without an appropriate injectable service code." Has something changed mid year to make these codes not be payable?
 

trarut

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Not sure where you are but Anthem Professional Reimbursement Policy C-12005 for IN/KY/MO/OH/WI titled Injectable Substances with Related Injection Services effective 5/1/19 states "The Health Plan requires that claims for injection services performed in an office setting must include the applicable Healthcare Common Procedure Coding System (HCPCS Level II) for the injected substance. If no HCPCS Level II code is submitted, the claim will deny. In some cases, coding rules may require the use of a comprehensive code instead of reporting an injection code plus the injected substance."

I can't post an attachment right now but you should be able to search online for the policy document.
 

sfirth1

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I'm in Georgia. Since this is the first denial I've seen and the letter I found from Anthem just has to use HCPCS Level II Code but doesn't list them Can anyone tell me the HCPCS code? Our office isn't a Medicare provider so I don't have a copy of the book. Is the code J1050?
 

cnramsey

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Patient came in for a Depo injection and the pharmacy provided the medication so I filed 96372 with Z30.42. The codes have been paid by all insurance companies all year long until now. Anthem is stating it was "reported without an appropriate injectable service code." Has something changed mid year to make these codes not be payable?
Some insurances require the J code with the 96372. In our office we will code the 96372 and J1050 and remove the charges on the J code since it's the patients own medication.
 

sfirth1

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Yes. Its for a Depo Provera Injection and the patient provides the medication. Thanks for your help! I'll file a corrected code w/ 96372 and J1050.
 

HarrisburgLPN

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The edit you're talking about is currently being looked at - apparently it wasn't taken into consideration that a member would bring their own injections in.

I can't guarantee that adding the J code and removing the charges will do anything, because by adding the J code you're saying the medication was given to the member BY the office from office supply. It could be inferred by the carrier that you're bundling the cost of the medication into the cost of the injection.
 

sfirth1

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Refiled claim w/ J code and now claim is denying with this reason " this service is denied because it is considered to be part of another service already performed and reimbursed" only charge on claim was for the injection. Anyone having luck getting 96372 paid by Anthem when patient brings in the medication? I don't know what to do other than appeal it but I'm not hopeful that would help get it paid. Suggestions?
 
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trarut

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It sounds like the correction is denied against the original claim submission. Ugh, insurance :( I would appeal the denial with an explanation of the circumstances and see what happens. As HarrisburgLPN mentioned above, the edit is being reviewed so they know brown-bagging happens. No guarantee they'll allow it but you'll know you've done everything you can.
 

NWCoder64

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We've had claims denied using just 96372 when patient's bring their own meds. We started billing 96372 with the J code but put the J code through with $0.01. The 96372 gets paid & the $0.01 gets written off.
 

sfirth1

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To update: Anthem paid 2 out of the 3 claims for 96372 w/ the J code added and $0 amount. I've refiled the denied one w/ J code and $0.01 charged to see if it will be reprocessed correctly this time.
 
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