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Billing ov for an injection

  1. #1
    Default Billing ov for an injection
    Medical Coding Books
    My Dr. wants us to start billing a 99211 along with the codes for a B-12 Injection. I have told him that is a big NO NO and I have it from one of the workshops that I attended. It says NO--See MCM 15502. I need to get a copy of this to prove to him that this won't fly with the carriers. Any other help would be greatly appreciated.


    Thanks
    Domemary

  2. #2
    Location
    North Carolina
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    3,126
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    D. Injection and Evaluation and Management Code Billed Separately on Same Day of Service.

    --Advise physicians that CPT code 99211 cannot be used to report a visit solely for the purpose of receiving an injection which meets the definition of CPT codes 90782, 90783, 90784, or 90788. Do not pay CPT codes 90782, 90783, 90784, or 90788 if any other physician fee schedule service was rendered. The drug is billed as a J code, whether the injection is separately billable or not. If no evaluation and management service or other service is provided on the same day as the injection, the injection code is billed.

    https://www.cms.gov/transmittals/downloads/R1725B3.pdf

    Page 38

  3. #3
    Default
    Thanks that is just what I needed, he likes to have something in real print and not me saying no.


    Thanks
    Domemary

  4. #4
    Location
    Glendale AZ
    Posts
    18
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    Just a warning, that is almost 10 years old and the injection codes listed are out of date. Under the description of 96372 in cpt is does state to use 99211 for injections given without direct physician supervision in office setting (out of office suite). So if it is a nurse injection without a physician present it would be the appropriate code.

    Traci, CPC

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Yet the concept still applies for Medicare...

    D- Drug Administration Services and E/M Visits Billed on Same Day of Service

    Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code (effective January 1, 2004). This drug administration policy was expanded in the Physician Fee Schedule Final Rule, November 15, 2004, to also include a therapeutic or diagnostic injection code (effective January 1, 2005). Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

    Page 43

  6. #6
    Location
    Evansville Indiana
    Posts
    451
    Default injection
    I agree with Rebecca. You cannot use 99211 for Medicare if the injection is given with no physician present since it would then not meet Incident to guidelines. If there is an injection code for the procedure you must bill that code and not the 99211.

  7. #7
    Location
    Glendale AZ
    Posts
    18
    Default
    I wasn't trying to upset anyone. I have physicians that request everything "in writing" as well. If I bring them something dated in 2001 they will call me out on it. The 96372/99211 issue does not apply to medicare. I was just stating that there are instances that 99211 would be reported for injections. We even have payors that request we specifically use the 99211 instead of 96372 on contraceptive visits.

    Traci, CPC

  8. #8
    Location
    North Carolina
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    3,126
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    Traci,

    No one took offense to your comment. This is a good place for, what I call, "healthy discussions". With RAC's and MIC's lurking in the background, we have to stay on our toes when it comes to compliance issues.

  9. #9
    Location
    Columbia, MO
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    12,531
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    Quote Originally Posted by anthemfamily View Post
    I wasn't trying to upset anyone. I have physicians that request everything "in writing" as well. If I bring them something dated in 2001 they will call me out on it. The 96372/99211 issue does not apply to medicare. I was just stating that there are instances that 99211 would be reported for injections. We even have payors that request we specifically use the 99211 instead of 96372 on contraceptive visits.

    Traci, CPC
    I cannot think of anytime a 99211 is appropriate to use for an injection. I have tried many times to wrap my brain around it and it just does not come out. The reason most want to use the 99211 instead of the 96372 is payment.
    I think Rebecca said it best in a different post quoting directly from the CPT book. If I may paste here from that post:
    CPT Professional Edition 2010-(beginning pages)

    Instructions for use of the CPT Codebook

    "Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided."

    To select another CPT code to simply get it paid is a false claim. If audited, the carrier will recoup the payment and potentially impose fines.
    __________________
    Rebecca CPC, CEMC

    So I feel that this alone is enough to state you do not use a 99211 for an injection when a code exists for that purpose. As far as some payers requesting you to do so for contraception, I would really question why and get it in writing!

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Location
    Glendale AZ
    Posts
    18
    Default
    Debra,
    CPT states in the instructions under code 96372 when to use 99211. Medicare does not follow these guidelines, but some payors do.

    Traci, CPC

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