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96372 Inj, therapuetic,prophylactic

  1. #1
    Default 96372 Inj, therapuetic,prophylactic
    Medical Coding Books
    I am new to the forum and I looked thru the past threads and couldn't find anything to help so am going to toss this out there for advise.

    In the last 6 months BCBS and Aetna have not been paying for this code, they were prior to this. We often give 2 injections at 2 different sites and we were told by BC BS that we had to add a modifier 76 to the 2nd 96372 but they are not paying for any code of 96372. Are others having this problem?

    I spoke to Principal the other day after recieving a denial for that code. They told me that we were not to be billing this code anymore and the charge for giving the injection was to be included in the cost of the antibiotic. I specifically said to her "what you are saying is that I am to increase the cost of my serum to make up for the administration?" She said yes. I have not heard anything about doing this. I have my new CPT book and 96372 is in that book.

    Help!! are others having this code denied recently? Is there another code I should try? These are antibiotic and pain management injections we are giving.

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    you do not add a 76 to a second 96372. This is not a repeated sevice because as you have stated it is 2 different injections at 2 different sites so the second injection is distinct and separate so you need a 59 modifier. Now as far as BCBS and Aetna or any other payer is concerned it is a valid coe and you can bill for 2 injections on the same day, you need to lok at the reason for the rejection, is it due to the diagnosis? Can you provide the reason for the denial?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Are you giving the same Drug in 2 different Sites ? Are you giving them at the Same time?

  4. #4
    Default
    I have heard of specific payers (especially BC) asking for the -76 modifier....but I agree that this may have to do with diagnosis. Do you have supporting DX that covers both injections and are they linked properly to your codes? I would also be sure to verify that these are not being denied as "noncovered services" which would be billable to the patient.

    Adrianna Plummer, CPC, CPMA

  5. #5
    Default
    We are giving 3 different drugs. 2 of which can be mixed together thus 2 seperate injections, and are given 1 in each buttocks. I didn't feel a 76 was correct but both BCBS and Aetna said that was how we had to bill. WE give an antibiotic,a steroid and a pain medication. We bill for sinusitis or tonsillitis. Blue cross,even with 1 injection, doesn't pay for the 96372. They do pay for the serum.

    My Aetna denial says" This charge is for a service that is considered incidental to another procedure performed on the same date of service. Do not bill the member. We billed a 30802, 96372, J2010, J0704, 96372, J1885.

    Thank you for your advise.

  6. Default
    Quote Originally Posted by mmorneau View Post
    We are giving 3 different drugs. 2 of which can be mixed together thus 2 seperate injections, and are given 1 in each buttocks. I didn't feel a 76 was correct but both BCBS and Aetna said that was how we had to bill. WE give an antibiotic,a steroid and a pain medication. We bill for sinusitis or tonsillitis. Blue cross,even with 1 injection, doesn't pay for the 96372. They do pay for the serum.

    My Aetna denial says" This charge is for a service that is considered incidental to another procedure performed on the same date of service. Do not bill the member. We billed a 30802, 96372, J2010, J0704, 96372, J1885.

    Thank you for your advise.
    Since you are billing these on the same date as a procedure (30802), you would need to add 59 to the 96372. Otherwise, they are going to bundle with the 30802.

  7. #7
    Default
    Thank you all very much.

    I went back and looked at all the ones that had denied and sure enough they are on the 30000 procedure codes. It didn't make sense looking at them one by one but now that I have looked at them together "the light bulb came on" . I came from 23 yrs of Endocrinology to ENT and what a difference. It's great learning something new but oh my gosh.........

    Again I appreaciate everyone's advise and help

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