Wiki RAC audit - CPT 96401

[DKozenieski]

We are receipt of a RAC audit for long time use of CPT code 96401. The pt obtains Avonex from the VA, brings it to our office, and office clinical staff inject intramuscularly. A B/P and pulse are taken. The pharmaceutical company told us to use 96401. However, I do not know that this is the correct code, especially since we received the RAC. The company thinks we need to obtain the medication receipts from the patient, and reply to the RAC as the code being justified. The physician did not see the pt, did not inject, and did not observe in any way. I need to know if this code is correct or is there another injection code that would better fit this scenario, or should it have been just a nurses visit, 99211? Thanks

 

[eadun2000]

We are receipt of a RAC audit for long time use of CPT code 96401. The pt obtains Avonex from the VA, brings it to our office, and office clinical staff inject intramuscularly. A B/P and pulse are taken. The pharmaceutical company told us to use 96401. However, I do not know that this is the correct code, especially since we received the RAC. The company thinks we need to obtain the medication receipts from the patient, and reply to the RAC as the code being justified. The physician did not see the pt, did not inject, and did not observe in any way. I need to know if this code is correct or is there another injection code that would better fit this scenario, or should it have been just a nurses visit, 99211? Thanks

I would think you would use 96372.. however, of course I could be wrong.

 

[DKozenieski]

96372 requires physician to do injection. It states "physicians do not use 96372 for injections given without direct supervision and should be reported with 99211. Hospitals, however, can use 96372 without direct physician supervision. Thanks for the reply.

 

[eadun2000]

96372 requires physician to do injection. It states "physicians do not use 96372 for injections given without direct supervision and should be reported with 99211. Hospitals, however, can use 96372 without direct physician supervision. Thanks for the reply.

Um I think you are confused. The PHYSICIAN himself does not need to be the one to give the injection. A nurse, MA, PA, whatever back office staff you have can do the injection. The physician just has to be in the building. Also, just as an FYI, you cannot code for a 99211 either if the physician is not in the building. It should have been billed with a 96372 and not the chemo injection code you were billing with.

 

[Sandy Stevens]

Avonex is a biological response modifier (generic: interferon beta-1a) When administered in a physician office setting the nurse may inject (IM) under the guidance and supervision of a physician. CPT 96401 describes correct administration technique and the drug class, therefore, it is the correct administration code, and depending on the dose, either, J1825 interferon beta-1a, 33 mcg –or- J1826 interferon beta-1a, 30 mcg should be reported.

Patients may self-inject only if their physician determines that it is appropriate and with medical
follow-up, as necessary, after proper training in intramuscular injection technique