Wiki Rocephin w/ Admin w/ 99211...yes or no?

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Bchase11

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Good morning,

My practice wants to bill a J0696, 96372, AND a 99211 for pts who come see the nurse to get a Rocephin injection. I told them they cannot according to the NCCI edits; that the E/M is in the injection admin code 96372. They're saying yes they can. HELP!!!!!!!
 
You can refer them to the NCCI policy manual, Chapter XI, which states: "The drug and chemotherapy administration CPT codes 96360-96375 and 96401-96425 have been valued to include the work and practice expenses of CPT code 99211 (evaluation and management service, office or other outpatient visit, established patient, level I). Although CPT code 99211 is not reportable with chemotherapy and non-chemotherapy drug/substance administration HCPCS/CPT codes, other non-facility based evaluation and management CPT codes (e.g., 99201-99205, 99212-99215) are separately reportable with modifier 25 if the physician provides a significant and separately identifiable E&M service."

You can also pull up the NCCI PTP edit tables and show them that the code pair 96372 with 99211 is on the table with a '0' indicator, 'modifier not allowed', with a rationale of "Misuse of column two code with column one code".

Both of these sources are available on the CMS Medicare web site. Any payers that follow NCCI will deny 99211 and there is no modifier to override this bundling.
 
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