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billing 99211 with 93672

  1. #1
    Smile billing 99211 with 93672
    Medical Coding Books
    Hello: I wondered if anyone knows if it is ok to bill a 99211 with administration code 93672 if the nurse actually checks the patients vitals?

  2. #2
    Overland Park, KS
    I will wager an opinion here.

    I will speak from the CMS perspective.

    Per the NCCI Edits, 99211 is considered bundled into 96372. The CCM indicator is 0 meaning you can't break the edit. In other words, 99211 can't be reported in conjunction with 96372 to CMS.

    Generally the services that a nurse would perform when administering an injection (i.e., taking vitals, etc) are considered inclusive of the injection code.

    While CMS does not allow 99211 to be reported with 96372, other payers may allow you to report it if the nurse visit is significant and separately identifiable from the injection itself and you would append modifier 25 to 99211. I would recommend consulting with the payer in question for further guidance.

    Hope this helps and again this is my opinion.
    Last edited by dballard2004; 02-02-2011 at 08:55 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  3. Smile
    Per the CPT guidelines written under the code for 96372 it clearly states that a physician should not report 96372 without direct physician supervision. to report use 99211. Only hospitals may report 96372 when the physician is not present.

  4. #4
    Columbia, MO
    Yes but you cannot report a 99211 without a physician in the office suite area since it is a physician level you are billing.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Check with your carrier as well - I just read in the SC Medicaid Provider Manual that they will allow a provider to bill a 99211 with the 96372; however, BCBS will never pay those two codes together.

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