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E/M with 96372 - Would I need to use a modifier

  1. Default E/M with 96372 - Would I need to use a modifier
    Medical Coding Books
    Would I need to use a modifier on an E/M service when billing the 96372 injection code? Here is the scenario, A child comes in and the doctor dx otitis media the doctor then decides to give the patient an injection of rocephin we are billing the 99213 the j code for the rocephin and the 96372 for the administration but our E/M services are being denied stating that they are inclusive of the 96372.

    Any help would be appreciated

    Denise Smith CPC, CEMC

  2. #2
    Columbia, MO
    You will need the 25 modifier on the ov code.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    I agree, you need the 25 on the E/M

  4. #4
    Just to clarify, you would need a 25 modifier on the same DOS as 96372 in any situation that allows you to bill both. Vaccine admin codes don't create the need for a E/M modifier, but therapeutic/prophylactic injection admins do. Hope that helps!

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