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96372 or not?

  1. Default 96372 or not?
    Clearnace Sale
    Can I code the E/M, 96372, and the J code when the patient comes into the physicians office for a URI and is given an injection? I've been told that I can only code the E/M and the J code because the patient only came in for the URI with no additional dx's...I don't agree what that though...I believe I should code 465.9, 99213-25, 96372, and J-code...please help me with this.

    Has anyone ever heard that you can't bill the administration code because of the same dx?

  2. Default 96372 or not?
    I just ran into this problem recently. You need to post the E&M and the J code. Do not use the 96372. Even if you have a different dx you still cannot bill for the 96372.

  3. Default
    You can bill the 96372 along with the e/m- w/mod 25 and j code with the same dx for all three procedures. Look in the Medicare Carriers Manual 30.6.7 section D for "backup" of this. I have billed traditional Medicare, Medicare HMO's and various other commerical payors and do get pd on all the procedure codes. Your BC plans don't want to pay with the same dx attached to the three procedure codes. We do bill so if in the future a ruling is made that they should have paid us, then we don't have to go back and refile the 96372.

  4. #4
    Location
    Adirondack Chapter of Professional Coders, Glens Falls, NY
    Posts
    26
    Default
    Yes, I agree with Lifeisgood. Bill the E/M with modifier 25 and also code the J code and the 96372. If you are injecting the drug, you would code for the injection. We have instances where our patients bring in their own drugs and we still charge for the 96372 and get paid.

  5. Default
    I agree because that's the way I've always coded it...with the E/M-25, 96372, and the J code.

  6. Default E/M, J codes and 96372
    Hi all

    Just remember as a rule always accompany a 96372 with any J codes. If you have an E/M then you add the mod 25 to the E/M.

    Hope this helps

  7. #7
    Location
    Lancaster County
    Posts
    28
    Default
    I agree. We always post the 96372 with the J code and 25 modifier on office visit!

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