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99211 vs 96372 if patient brings meds

  1. #1
    Location
    Greenville, SC
    Posts
    51
    Default 99211 vs 96372 if patient brings meds
    Medical Coding Books
    If a patient is seen in the office and they bring their own medication and all they come in for is their shot would the office charge the 96372 or a 99211? Such as the case for Depo Provera...patient purchases and then brings to the office for a nurse to administer.

  2. #2
    Default
    Since the nurse is performing the administration, 96372 is the code that should be billed. When they are seeing a patient and perform some evaluation and management, such as for a patient that is in with high BP and they assess, take information and pass it on to the physician, then they'd bill 99211.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    Location
    Greenville, SC
    Posts
    51
    Default
    Is the payer not going to reject because the drug is not being charged for? I didn't know if the system would prompt for the drug due to the injection code.

  4. #4
    Location
    Dover Seacoast New Hampshire
    Posts
    2,016
    Default
    Most of our payers ask for the drug name in box 19 of the HCFA. Pam Brooks

  5. #5
    Location
    Greenville, SC
    Posts
    51
    Default
    If you are not billing for the drug, and you leave out that box in the HCFA, are you getting paid for the administration?

    I'm just wondering if the administration code will automatically prompt for the drug to be billed....hence billing the 99211 nurse service would be more practical.

    Thoughts?

  6. Default
    You would bill for the 96372 if you have physician supervision. If not, bill for 99211. List your drug given on line item for 96372.

  7. #7
    Location
    Greenville, SC
    Posts
    51
    Default
    but the issue is: you are not billing for the drug. the patient brought the drug into the office themselves

  8. #8
    Default
    We have many patients that bring in their own drug. We bill for the administration of the drug, and our system allows us a note where we key the drug and dosage being administred.

    Or, you could add another line item for the drug with a $0 charge and a note here, pt own med.

    We do get paid for the administrations.

    Tracy

  9. #9
    Location
    Greenville, SC
    Posts
    51
    Default
    sounds great! Thanks everyone!

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