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Therapeutic, prophylactic and diagnostic injections and infusions

  1. Question Therapeutic, prophylactic and diagnostic injections and infusions
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    Looking for some input. CPT codes in the therapeutic, prophylactic and diagnostic injection and infusion section, 96365-96376, state "specify substance or drug" when coding. If the provider is not actually supplying the drug or substance, do you actually code for the J code on the claim with a zero dollar amount or 1 cent depending on your system limitation?

  2. #2
    Everett, WA
    our particular software system DOES allow for the zero dollar amount when patient purchases the medication in advance. It's usually the medication for the therapeutic injections of botox , J0585. ---Suzanne

  3. Default Therapeutic, diagnostic and prophylactic injections and infusions
    Thank you Suzanne. Is it your office's typical practice to bill the J code with a zero dollar amt if patient picks up the medication? Do you read the statement in CPT "specify substance or drug" to mean that regardless of whether you are billing a dollar amount for the drug or not, you must still list the J code on the claim? Thanks.

  4. #4
    Our office does a great deal of injections and if the pt brings in the medication we will properly store & label the med for pt use. For billing purposes we bill the admin code which applies and bill the J code with a 0.01 for medicare and 0.00 for all other carriers. This will marry the two codes being billed out together and give the ins carriers an idea of what you are administering.

  5. Default
    Thank you!

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