Medicare and cpt code 96372

[Restevez1989]

Hi, I have noticed Medicare is only paying cpt code 96372 for one unit. I have billed the office visit with modifier 25 along with multiple injections but they only pay for one administration fee. Any advice would be great! Thanks!

 

[debbiek]

Are you billing the 96372 showing a multiple quantity, or are you putting them on individual line items for each one?

 

[Restevez1989]

I am billing them as separate line items. In the past they have denied the entire claim if I had put more than one unit.

 

[mitchellde]

Are you using the XS modifier on the second 96372?

 

[Restevez1989]

No I have not tried modifier XS

 

[Restevez1989]

Tried using modifier XS and it just came back denied. =(

 

[mitchellde]

what are the drugs and diagnosis submitted

 

[Restevez1989]

J1100 AND J1885 with DX M15.9
I attached the modifier to 96372

 

[mitchellde]

it could be several issues.. first you are using a very general and unspecified diagnosis for a specific treatment. Second was this delivered IM or as a joint injection.

 

[Restevez1989]

This is true. The doctors are very quick to pick a code with the least specificity. I have been working with them to improve this and to add more documentation.

The injections were given IM.

 

[mitchellde]

have you reviewed the note? what does the documentation support

 

[Restevez1989]

The documentation is very vague and doesn't specify much besides a fall. I will query the provider for clarification.

I do have amazing news, I just got a claim from Medicare that paid both administration fees with the modifier XS!

Thank you so much! You are a super star