Wiki Injection fee - when billing a non-vaccine injection

[krackers]

I had always been told that when billing a non-vaccine injection with an OV that you didn't bill an injection fee (96372), that it was included in the OV. Recently one of our provider's took their child to a different clinic. They billed a 99213 (with a 25 modifier), Zofran and the injection fee 96372 and added a 59 modifier to it. There were 2 different diagnosis, diarrhea on the OV and vomiting on the Zofran and the injection fee. The provider was paid on all three charges. Now our provider wants us to bill the same way. lI've asked numerous individuals if this is correct billing and I've received mixed answers. I'm concerned that using the 2 modifiers is just trying to get around the scrubs. Can anyone assist me with this problem?

 

[jmcpolin]

If the decision to do the injection is made at the time of the visit I always code the E&M with a 25 modifier and then the 96372.

 

[mitchellde]

absolutely correct, I have never had to add the 59 to the injection and would not but I know that some do. You do not however bill an office visit when the patient is scheduled to receive the injection, then you bill the injection admin only.