AAPC - Back to school
Results 1 to 4 of 4

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

  1. #1

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

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    Columbia, MO


    You will need the 25 modifier on the ov code.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    I agree, you need the 25 on the E/M

  4. #4
    Join Date
    Apr 2007
    Lubbock, TX


    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!

Similar Threads

  1. 96372 or not?
    By kishacajun in forum Family Practice
    Replies: 6
    Last Post: 02-09-2015, 12:43 PM
  2. E/M with 96372 - When we do our quarterly visits
    By Danielle in forum Dermatology
    Replies: 2
    Last Post: 10-24-2014, 01:30 PM
  3. 99215,96372,96372, j2550, j0282
    By nelstx2 in forum Medical Coding General Discussion
    Replies: 6
    Last Post: 12-08-2013, 07:24 AM
  4. 96372 - When it it appropriate to use this code?
    By cpatty476 in forum Billing/Reimbursement
    Replies: 4
    Last Post: 03-09-2013, 08:59 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.