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96372 - I am questioning the appropriate

  1. Question 96372 - I am questioning the appropriate
    Medical Coding Books
    I am questioning the appropriate coding for multiple injection administrations. We have been submitting with 2 units when 2 separate injections are administered. Most insurances do pay for 2 units, which is most helpful since the Jcodes are paying so little now and often don't even cover our costs. However, we have one insurance that has now notified us that multiple units are not appropriate and are recouping (!!!!) their overpayments. I'm searching for any "official" information that would specify whether or not multiple units are appropriate for use with this code. The instructions at the beginning of the section in the CPT book (page 435 in the AMA Professional Version) do not address the multiple units issue. Anybody got any ideas about where to locate such info? I'm looking for something "official" to use in rebutting the insurance company's decision to recoup. It's going to affect a lot of claims and create a bit of a mess in our billing system.

    Thank you.
    Jennifer Holland, CPC
    Columbia, KY

  2. Default 96372 Again
    We have contacted the provider rep at Anthem (BC/BS), which is the ins co that is recouping pmts for multiple inj administrations. She says that "there are flat fee codes and codes that pay units". Does this sound like anything that is verifiable through the CPT books or do you think this is just an ins co's own rules to enable them to reduce pmts? If it's referenced in the CPT book, can you direct me on where to look, because I haven't been able to find anything. Thanks.
    Jennifer H, CPC
    South Central KY
    Jennifer Holland, CPC
    Columbia, KY

  3. #3
    Default 96372
    Per the status indicator of 0 for CPT 96372, no payment adjustment rules for multiple procedures apply for 96372.

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