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B12 injection in the office

  1. #21
    Location
    Columbia, MO
    Posts
    12,531
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    Medical Coding Books
    Quote Originally Posted by Brenda879 View Post
    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
    CMS has no idea there was no provider around for this encounter. It was billed I am sure using the physician NPI. Under no circumstance can a 99212 be charged if there is no provider face to face with the patient. I would have the relative request a copy of the documentation and then contact CMS for a review.

    Debra A. Mitchell, MSPH, CPC-H

  2. #22
    Default
    It has been my understanding that as long as a physician ordered something for a patient and there is documentation in the chart of that, ie shot of B12 or methotrexate for a diagnosed condition that is being followed by the MD, that it is perfectly acceptable for the nurse to give the injection and charge 99211 with the injection J code even if the MD is not present. If the MD was not in the room, but was available in the facility, you would use 96372 instead of 99211. Please show me documentation that disagrees with this if I am understanding this incorrectly.

    96372 below states: (Physicians do not report 96372 for injections given without direct physician supervision. To report, use 99211. Hospitals may report 96372 when the physician is not present)

    Also in the back of my current CPT book are examples for a 99211:

    Office visit for a 69-year-old female, established patient, for partial removal of antibiotic gauze from an infected wound site. (Plastic Surgery)

    Office visit for an 82-year-old female, established patient, for a monthly B12 injection with documented Vitamin B12 deficiency. (Geriatrics/Internal Medicine/Family Medicine)

    Office visit for a 50-year-old female, established patient, seen for her gold injection by the nurse. (Rheumatology)

    Office visit for a 45-year-old male, established patient, with chronic renal failure for the administration of erythropoietin. (Nephrology)

    Office visit for a 42-year-old, established patient, to read tuberculin test results. (Allergy & Immunology)

    Office visit for 14-year-old, established patient, to re-dress an abrasion. (Orthopaedic Surgery)

    Office visit for a 23-year-old, established patient, for instruction in use of peak flow meter. (Allergy & Immunology)

    Office visit for prescription refill for a 35-year-old female, established patient, with schizophrenia who is stable but has run out of neuroleptic and is scheduled to be seen in a week. (Psychiatry)

    Office visit for a 9-year-old, established patient, successfully treated for impetigo, requiring release to return to school. (Dermatology/Pediatrics)

    Office visit for an established patient requesting a return-to-work certificate for resolving contact dermatitis. (Dermatology)

    Office visit for an established patient who is performing glucose monitoring and wants to check accuracy of machine with lab blood glucose by technician who checks accuracy and function of patient machine. (Endocrinology)

    Outpatient visit with 19-year-old male, established patient, for supervised drug screen. (Addiction Medicine)

    Office visit with 31-year-old female, established patient, for return to work certificate. (Anesthesiology)

    Office visit for a 45-year-old female, established patient, for a blood pressure check. (Obstetrics & Gynecology)
    Heidi Thompson, CPC

  3. #23
    Location
    Columbia, MO
    Posts
    12,531
    Default
    If you are billing a place of service 11 then you may not use the physician NPI if that physician is not present in the office while the patient is being seen. The nurse is an employee of the physician and can perform any task dictated to her that falls within the scope of her practice as long as the physician is on site. I do not know why the AMA book says what it says but you cannot charge a 99211 to give an injection and you may not charge a 99211 for a nurse encounter if the physician is not onsite if you are a physician office.

    Debra A. Mitchell, MSPH, CPC-H

  4. #24
    Smile B12
    I understand CMS would not know about no physician on the premisis. I was just giving Jenny an example of what codes were used to get paid for b-12 injection by CMS.
    Thank you all for your input and I do get 99212 now.

    Thanks again,
    Brenda

  5. #25
    Default
    the correct codes to use for B12 are as most others said :

    96372 ther/diag inj &
    j3420 is the B12

  6. #26
    Default Units J3420
    I have a question regarding units for the J3420. I have seen Medicare pay on 2 units but most of the time Medicare denies the 2 to 3 units as CO-151. Is there some rule of thumb to go by? Any input would be greatly appreciated.

  7. Default
    Medicare no longer pays for the j3420 as they deem it a med the patient should be able to give themselves so the 96372 is still payable but the j3420 will be denied pt liability

  8. Cool B12
    You can not bill a 99211 if the pt came in for the B12 shot. You would bill J3420 with 96372, no E/M
    Quote Originally Posted by theresafuscocpc@gmail.com View Post
    BS denied the admin 96372 portion for a B12 inj stating it is inclusive in the E/M visit of the same day, claiming it to be a CMS guideline. Can anyone comment on that?

  9. #29
    Default
    If you had an office visit along with the injection you're going to need modifier 25 on the e/m to show it's a separately identifiable service. If there was a substantiated office visit in addition to the injection.



    Quote Originally Posted by theresafuscocpc@gmail.com View Post
    BS denied the admin 96372 portion for a B12 inj stating it is inclusive in the E/M visit of the same day, claiming it to be a CMS guideline. Can anyone comment on that?
    Last edited by caramella025; 06-23-2016 at 03:32 PM.
    Melanie Wright, CPC

    Some days you're the bug, , some days you're the windshield.

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