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B12 injection in the office

  1. #11
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    Columbia, MO
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    Medical Coding Books
    CMS reversed their guideline on this in 06, prior to that it was a CMS guideline to include the injection with the OV. Go to the transmittals section of the CMS website and look in 2006 for a transmittal on injections and ov with the 25 modifier. you do have to use modifer 25 on the OV.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12
    Default b-12
    Just starting a billilng company, so I don't have a client yet, but a relative went to physicians office, for a b-12 shot only, given by the nurse, no physician was in the office and they submitted codes
    99212
    96372
    J3420
    G8446 and Medicare approved all except the G code. I hope this helps you.
    My issue is I know this was submitted wrong. But I was hoping to know the correct way to charge a nurse visit with b-12 injection only, given by the nurse and no physician on the premises. If anyone would like to give an opinion I would greatly appreciate it.

    Thanks, Brenda

  3. #13
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    Columbia, MO
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    There is no way to charge for nurse services if there is no physician or Nurse practioner on site to supervise and then whoever is supervising to bill under.

    Debra A. Mitchell, MSPH, CPC-H

  4. #14
    Default b-12
    So if the nurse turns out to be a NP how would you code this?


    Thanks for being so patient.


    Brenda

  5. #15
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    Patient received B12 shot only, with no full ofice visit done. The injection was given by a NP with no physician directly supervising. You would code 99211.
    Walker Bachman, CPC, CPPM

  6. #16
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    Thank you very much!

    Brenda

  7. #17
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    Debra, I looked up the CMS 2006 transmittal for more clarification. Thank you for the info. I posted it here for others that may be confused.

    The CPT 2006 includes a parenthetical remark immediately following CPT code 90772 (Therapeutic, prophylactic or diagnostic injection; (specify substance or drug); subcutaneous or intramuscular.) It states, “Do not report 90772 for injections given without direct supervision. To report, use 99211.”

    This coding guideline does not apply to Medicare patients. If the RN, LPN or other auxiliary personnel furnishes the injection in the office and the physician is not present in the office to meet the supervision requirement, which is one of the requirements for coverage of an incident to service, then the injection is not covered. The physician would also not report 99211 as this would not be covered as an incident to service.

    Brenda

  8. Default
    I am having the same issue getting injections paid. However, in my opinion for your case...I would question if there really is a significant and seperately identifiable E/M code. If this is a scheduled B12 shot, and thats specifically what the pt was scheduled for, I'm curious as to what E/M you would bill. I'm in Urgent Care and we often bill for therapeutic injections (pain management), and I have SUDDENLY gotten a ton of rejections for this code from BS (the ONLY insurance stating this) that it is inclusive. I have been back and forth with 2 different BS reps, mailed appeals..and have gotten nowhere!!! I'm interested in the fact you received a response that it was due to CMS guidelines. I have never even received that much of a response! My theory is that this is a claims software issue with incorrect edits, but trying to get anyone that has a clue there to research it is easier said then done. Any help would be appreciated!!

  9. #19
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    Quote Originally Posted by Walker22 View Post
    Patient received B12 shot only, with no full ofice visit done. The injection was given by a NP with no physician directly supervising. You would code 99211.
    An NP does not need a physician to perform injections and should bill a 96372 for any injection but you will need to bill under the NP number not the physician if the physician is not on site.

    Debra A. Mitchell, MSPH, CPC-H

  10. #20
    Default
    Quote Originally Posted by jenny143me View Post
    I am having the same issue getting injections paid. However, in my opinion for your case...I would question if there really is a significant and seperately identifiable E/M code. If this is a scheduled B12 shot, and thats specifically what the pt was scheduled for, I'm curious as to what E/M you would bill. I'm in Urgent Care and we often bill for therapeutic injections (pain management), and I have SUDDENLY gotten a ton of rejections for this code from BS (the ONLY insurance stating this) that it is inclusive. I have been back and forth with 2 different BS reps, mailed appeals..and have gotten nowhere!!! I'm interested in the fact you received a response that it was due to CMS guidelines. I have never even received that much of a response! My theory is that this is a claims software issue with incorrect edits, but trying to get anyone that has a clue there to research it is easier said then done. Any help would be appreciated!!
    CMS paid for 96372 & J3420 with 99212, the issue with this was there was no physician or NP in the building. This isn't a client, I discovered it when reviewing a relataives EOB.

    Brenda

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