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Need help with 96372

  1. Unhappy Need help with 96372
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    We have a patient that is coming in for Neupogen J1440,
    Neumega J2355, and Procrit J0885 on the same day. We are billing is out
    96372-59 J1440
    96372-76-59 J2355
    96372-76-59 J0085

    And medicare is paying for the first two sub-q but not the third, they are say it is a dup. We are also tryed billing it out with 96372-59 quanity 3, but you can't have no more than one quanity on the 96372. Is their any other way to bill this out. Please help

  2. #2
    Location
    Columbia, MO
    Posts
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    You need to drop the 76 as these are not repeated services they are each one performed at separate sites which makes them distinct procedures all performed in the same setting you should do fine with
    96372
    96372 59
    96372 59
    I have noticed that if you put the 59 on the first listed code Medicare as well as other carriers will deny the rest as duplicate however leave the first line modifier free and this does not happen.
    An example of the 76 is EKG, when the physician has the first one done and then repeats the test again after an intervention, or an xray which is repeated after a reduction of the bone is performed.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default code96372
    If a female patient is seen for a well person visit (99395 for example) and during the course of the visit she receives an injection of depoprovera ( the pt. brought her own meds), can you bill a 99395 and a 96372? If so would you use a modifier? We have a difference of opinion and would like to find out.

  4. #4
    Location
    Columbia, MO
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    12,570
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    Yes you would use the 25 on the 99395. There was a CMS transmittal on this back in July of 06 which stated that a 25 modifier was necessary on the OV code when an injection was also adminiatered in the course of the OV.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default 96372
    I fully agree with the comment that you need to drop the -59 modifier from the first service and then also drop the -76 modifier from the 2nd and 3rd services. None is a repeat procedure because there are 3 different medications being given. The billing sequence should be 96372, 96372-59 and 96372-59. This is exactly how I billed this scenario for chemotherapy infusions and never received a denial...the "J" codes will drive each 96372.

    Good luck!

    Joyce

  6. #6
    Default
    Quote Originally Posted by Wendy Pasco View Post
    If a female patient is seen for a well person visit (99395 for example) and during the course of the visit she receives an injection of depoprovera ( the pt. brought her own meds), can you bill a 99395 and a 96372? If so would you use a modifier? We have a difference of opinion and would like to find out.
    I never seen this scenerio in the GYN clinic. If patient has period they can not do complete GYN exam. Can not bill preventive code.

    If they did GYN exam and do bill preventive code they ask the patient to do her lab (pregency test)and come back next day for depo shot.

    I work for the hospital

  7. #7
    Default
    This is interesting...

    ...any other opinions?

  8. Default
    Quote Originally Posted by kumeena View Post
    I never seen this scenerio in the GYN clinic. If patient has period they can not do complete GYN exam. Can not bill preventive code.

    If they did GYN exam and do bill preventive code they ask the patient to do her lab (pregency test)and come back next day for depo shot.

    I work for the hospital
    All well and good, but many clinics have the patients complete the preg test prior to the gyn exam. Also, a depo shot does not necessarily have to go along with a gyn exam- a preventative can also be just a regular physicla, with the gyn split to another exam completely with a well-woman ICD-9.

    So yes, OV gets a -25 with an injection.

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