Hello.
I recently was asked if we can bill the 96372 with -59 modifier for injection of B12 or other theraputic drugs on the same Date of service as the Chemo administration 96402 (Lupron). Their concern was it seemed like the need for the B12 stems from the Chemo given, so can it still be considered "seperate and distinct" to use the -59? This person was unable to find anything speaking on it in the NCCI manual and doesn't want to bill Medicare inappropriately.
My thinking was that this was moreso referring to an E/M level along with the 96372 is now bundled with the E/M level if on the same day and the reason for visit is the regarding the same dx for the injection given that day. I think it is appropriate to bill the 96372 -59 along with the 96402 if no E/M service was provided that day. One is for the Chemo (96402) and one is for prevention while being treated (96372-B12).
If anyone has any MC guidelines to clarily this please let me know or if someone has any insight as things are changing all the time.
Thanks.
I recently was asked if we can bill the 96372 with -59 modifier for injection of B12 or other theraputic drugs on the same Date of service as the Chemo administration 96402 (Lupron). Their concern was it seemed like the need for the B12 stems from the Chemo given, so can it still be considered "seperate and distinct" to use the -59? This person was unable to find anything speaking on it in the NCCI manual and doesn't want to bill Medicare inappropriately.
My thinking was that this was moreso referring to an E/M level along with the 96372 is now bundled with the E/M level if on the same day and the reason for visit is the regarding the same dx for the injection given that day. I think it is appropriate to bill the 96372 -59 along with the 96402 if no E/M service was provided that day. One is for the Chemo (96402) and one is for prevention while being treated (96372-B12).
If anyone has any MC guidelines to clarily this please let me know or if someone has any insight as things are changing all the time.
Thanks.