Wiki Injection Code 96372 - We are giving on two seperate parts of the body

[TovKat]

Could someone please clarify if this code 96372 can only billed once if we are giving two different injections such as Rocephin and B12 shots! We are giving on two seperate parts of the body. Any answers and back up would be greatly appreciated
TovKat

 

[mitchellde]

You can bill it twice using the 59 modifier billing once with 2 units is not advisable. IMO

 

[pineapplelvr]

we bill 96372 X 2 etc all the time but has to be two different "pokes" (rt arm, lt arm, etc etc)

 

[swilliams2]

96372

We bill 93672 twice and on the second we add modifers 76 and 59. Works like a charm every time.

 

[mitchellde]

you never use 76 and 59 together, 76 should not be used for a second injection as it is not a repeated procedure, unless it is the exact same injection repeated in a different session on the same day. when 2 injections are given in the same session, then the second injection is a separate procedure (59) not a repeated (76)

 

[GaPeach77]

I have seen it billed/coded both ways but unfortunately many payers will not pay for more the one

 

[swilliams2]

modifiers

Debra, I respectfully disagree. If we administer two injections at the same encounter (B-12 and testosterone) and I bill 96372 twice and add the 59 to the second it will deny as a duplicate every time. The 76 tells the carrier I did the same procedure twice the 59 says they were two distinct procedures. When we administer two injections, we are in fact repeating the act of administration-76 is appropriate.

 

[mitchellde]

Sorry but per the Federal Register the definition of modifier 76 is:

Part - A Level I Modifiers 76

Description Repeat procedure by the same physician.
General Guidelines

A. Modifier –76 is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician.

B. This modifier may be reported for services ordered by physicians but performed by technicians.

C. The procedure/service code is listed once (without the modifier) and then the code is listed again with a modifier –76 added (two line items). The number of times the procedure/service was repeated is reported on
separate lines (with modifier –76
When two injections are given on the same encounter the second injection is NOT a repeated service it is a distinct and separate service which is the 59. This will not make it deny as a duplicate

 

[dmaec]

Debra, I respectfully disagree. If we administer two injections at the same encounter (B-12 and testosterone) and I bill 96372 twice and add the 59 to the second it will deny as a duplicate every time. The 76 tells the carrier I did the same procedure twice the 59 says they were two distinct procedures. When we administer two injections, we are in fact repeating the act of administration-76 is appropriate.

I've never coded multiple injections with a 76 modifier. If they're giving two DIFFERENT injections (one B-12, one something else, whatever) they are the same, it is not a repeat procedure. It's not the same. yes, it's an injection, but it's "another" separately reportable injection and should have a modifier .59 - we've never had a claim deny for "duplicate" especially with a 59 modifier on it.. the modifier itself tells them, it's NOT a dup! .. anyway, my vote is modifier .59 on the multiple injections.

 

[dmaec]

Sorry but per the Federal Register the definition of modifier 76 is:

Part - A Level I Modifiers 76

Description Repeat procedure by the same physician.
General Guidelines

A. Modifier –76 is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician.

B. This modifier may be reported for services ordered by physicians but performed by technicians.

C. The procedure/service code is listed once (without the modifier) and then the code is listed again with a modifier –76 added (two line items). The number of times the procedure/service was repeated is reported on
separate lines (with modifier –76
When two injections are given on the same encounter the second injection is NOT a repeated service it is a distinct and separate service which is the 59. This will not make it deny as a duplicate

yes indeed Debra! agreed 100% .. two injecitons of different sites, different meds, etc.. is NOT the "same" procedure.. they are different, and require - modifier .59! nicely written!

 

[larcwing]

Sorry but per the Federal Register the definition of modifier 76 is:

Part - A Level I Modifiers 76

Description Repeat procedure by the same physician.
General Guidelines

A. Modifier –76 is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician.

B. This modifier may be reported for services ordered by physicians but performed by technicians.

C. The procedure/service code is listed once (without the modifier) and then the code is listed again with a modifier –76 added (two line items). The number of times the procedure/service was repeated is reported on
separate lines (with modifier –76
When two injections are given on the same encounter the second injection is NOT a repeated service it is a distinct and separate service which is the 59. This will not make it deny as a duplicate

I'd agree with exception to, in the description in the book it states:

"It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service."

No where in that description does it state that it must be in a separate session or on a different day. But I do agree you do not use it for two different vaccines.

 

[mitchellde]

However in order to be a true repeated service it would have to be a different session. You would never perform the exact same procedure in the same session. For exame if you did an EKG there would be no need to repeat this again until the provide looks at the result and performs some form of intervention, and then repeats the test to see of there is improvement now you have repeated the same procedure but due to the intervention the second procedure is technically in a different session. The CPT book did not need to spell it out since the meaning was suppose to be obvious, and the federal register has the complete definition.

 

[larcwing]

We just had a case in where a patient come in for a physical and was given an audiometry exam and failed, then examined by the doctor and found to have impacted ceremun which was curreted and cleared. The audiometry was repeated and the patient passed. This was all done in the same visit, therefore we'd have to use the 76.

 

[mitchellde]

yes same visit but different sessions. Each audiometry was a different session due to the fact that there was a physician intervention between each session. you did not perform both audiometry one right after the other with no intervention. That is what is meant by different session, so you are correct to use the 76 for the second test.