Wiki MD administered injection?

[kathleenl]

Morning,
One of my OB/GYN's provided a Depo-Provera shot to his patient. He also took her blood pressure, did a urine pregnancy test, discussed the risks/benefits/ side effects. He has checked off 99213 on the superbill. I feel if the reason for the visit was the shot, then that is what we are to bill. Wouldn't 96372 be more appropriate? The description of that code does not specifically say that it includes the above details nor does what was documented warrant a 99213. I am trying to find something concrete to provide him because this is not the first time we have disagreed on this topic.

Any help/guidance is appreciated.

Thanks
-Kathleen

 

[ppalmer]

You can bill an office visit with 25 mod and the 96372. The doctor should get paid for any exam/medical decision making they did in addition to the admin fee. Most likely would be 99212 or 99213 depending on what is in the chart notes.

If the pt ONLY comes in and gets the shot and nothing else or does notsee the doc then 96372 only.

 

[mitchellde]

I disagree, the code would be the 96372, the patient was scheduled for the injection and received exactly what they were scheduled to get, you cannot charge an office visit for a scheduled procedure since the medical decision making and the assessment to determine the need for the injection was performed already and charged on the encounter where the decision was made. It does not matter if the physician or the nurse administer the injection the code would still be the 96372.