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B-12 Injection Conundrum

  1. #1
    Default B-12 Injection Conundrum
    Medical Coding Books
    Have a question about billing for B12 injections....

    I know that for Medicare patients if the coding is correct then Medicare will pay (albeit, pennies on the dollar). I am getting denials from all other insurance companies. If the patient is only coming in for an injection-regardless of the underlying coding, can the patient be held responsible for the injection? In other words, do I have to bill the patients insurance? Or can I inform the patient that we don't bill B-12 injections to private insurances and they are responsible for 100% of the injection?

    Any help would be greatly appreciated!

  2. #2
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    Quote Originally Posted by KKMeeks View Post
    Have a question about billing for B12 injections....

    I know that for Medicare patients if the coding is correct then Medicare will pay (albeit, pennies on the dollar). I am getting denials from all other insurance companies. If the patient is only coming in for an injection-regardless of the underlying coding, can the patient be held responsible for the injection? In other words, do I have to bill the patients insurance? Or can I inform the patient that we don't bill B-12 injections to private insurances and they are responsible for 100% of the injection?

    Any help would be greatly appreciated!
    Hi! I bill these injections a lot for the Oncology practice I code for and they are normally paid for by insurance if they are medically necessary. What dx code are you using? If the patient actually has a deficiency, you can use 266.2 or 281.1. I would first look on the commercial insurance websites for their medical policies to see if they have one for B-12 injections and how each insurance wants it coded. If you are receiving denials from 1 insurance company in particular, call and ask why, sometimes you will get someone nice who might tell you. :-) However, it is always best, after looking for medical policies, to inform the patient that the service may not be covered and if it is not covered, that they will be billed for the injection. Have them sign an ABN (for Medicare) or another form of documentation stating that they want to receive the service even if their insurance will not cover it and then you can bill the patient for the injection. I would check the order for the B-12 shot, the provider's documentation, anything you can to find out why or the dx for the injection before billing the patient directly. It's always best to do your homework just in case you have to speak directly with the patient who received a bill they thought would be covered. Best of luck to you!

    Chrissy, CPC

  3. #3
    Location
    Columbia, MO
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    12,913
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    Quote Originally Posted by HILLIC View Post
    Hi! I bill these injections a lot for the Oncology practice I code for and they are normally paid for by insurance if they are medically necessary. What dx code are you using? If the patient actually has a deficiency, you can use 266.2 or 281.1. I would first look on the commercial insurance websites for their medical policies to see if they have one for B-12 injections and how each insurance wants it coded. If you are receiving denials from 1 insurance company in particular, call and ask why, sometimes you will get someone nice who might tell you. :-) However, it is always best, after looking for medical policies, to inform the patient that the service may not be covered and if it is not covered, that they will be billed for the injection. Have them sign an ABN (for Medicare) or another form of documentation stating that they want to receive the service even if their insurance will not cover it and then you can bill the patient for the injection. I would check the order for the B-12 shot, the provider's documentation, anything you can to find out why or the dx for the injection before billing the patient directly. It's always best to do your homework just in case you have to speak directly with the patient who received a bill they thought would be covered. Best of luck to you!

    The dx of course always depends on what the providers documents as the patients condition. 266.2 and 281.1 are entirely different conditions and cannot be used interchangeably. Regardless of what he payer indicates is the payable code(s), you can only code for the patient's dx documented in the chart.
    As far as charging the patient without filing the claim, probably not. If you are a contracted provider you will need to submit the claim first and allow it to deny so the carrier can tell you what the patient responsible amount it.

    Debra A. Mitchell, MSPH, CPC-H

  4. Red face
    Just wanted to remind you that if you are a Rural Health Clinic, you cannot bill for JUST a B-12 shot. You will basically "eat" the cost albiet the costs will be reflected on your yearly cost reporting for which hopefully you will be able to recoup some of the loss.

  5. #5
    Location
    Roanoke, Virginia
    Posts
    125
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    My old office cut off ordering the B-12 serum and gave the patients a prescription to fill instead. When they came back for the injection we would bill CPT 96372 only. I never had any issues with Medicare or any other payer with the 266.2 diagnosis code. I can see where there'd be a problem if you were using a V code.

    I don't think you can not charge the patient's insurance if there's a contract in place with the insurance.

    Hope you find a resolution soon if you haven't already!

    Marlena

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