Results 1 to 5 of 5

RAC audit - CPT 96401

  1. Question RAC audit - CPT 96401
    Medical Coding Books
    We are receipt of a RAC audit for long time use of CPT code 96401. The pt obtains Avonex from the VA, brings it to our office, and office clinical staff inject intramuscularly. A B/P and pulse are taken. The pharmaceutical company told us to use 96401. However, I do not know that this is the correct code, especially since we received the RAC. The company thinks we need to obtain the medication receipts from the patient, and reply to the RAC as the code being justified. The physician did not see the pt, did not inject, and did not observe in any way. I need to know if this code is correct or is there another injection code that would better fit this scenario, or should it have been just a nurses visit, 99211? Thanks

  2. Default
    Quote Originally Posted by DKozenieski View Post
    We are receipt of a RAC audit for long time use of CPT code 96401. The pt obtains Avonex from the VA, brings it to our office, and office clinical staff inject intramuscularly. A B/P and pulse are taken. The pharmaceutical company told us to use 96401. However, I do not know that this is the correct code, especially since we received the RAC. The company thinks we need to obtain the medication receipts from the patient, and reply to the RAC as the code being justified. The physician did not see the pt, did not inject, and did not observe in any way. I need to know if this code is correct or is there another injection code that would better fit this scenario, or should it have been just a nurses visit, 99211? Thanks
    I would think you would use 96372.. however, of course I could be wrong.

  3. Default
    96372 requires physician to do injection. It states "physicians do not use 96372 for injections given without direct supervision and should be reported with 99211. Hospitals, however, can use 96372 without direct physician supervision. Thanks for the reply.

  4. Default
    Quote Originally Posted by DKozenieski View Post
    96372 requires physician to do injection. It states "physicians do not use 96372 for injections given without direct supervision and should be reported with 99211. Hospitals, however, can use 96372 without direct physician supervision. Thanks for the reply.
    Um I think you are confused. The PHYSICIAN himself does not need to be the one to give the injection. A nurse, MA, PA, whatever back office staff you have can do the injection. The physician just has to be in the building. Also, just as an FYI, you cannot code for a 99211 either if the physician is not in the building. It should have been billed with a 96372 and not the chemo injection code you were billing with.

  5. #5
    Location
    Nashville, Tennessee
    Posts
    35
    Default
    Avonex is a biological response modifier (generic: interferon beta-1a) When administered in a physician office setting the nurse may inject (IM) under the guidance and supervision of a physician. CPT 96401 describes correct administration technique and the drug class, therefore, it is the correct administration code, and depending on the dose, either, J1825 interferon beta-1a, 33 mcg –or- J1826 interferon beta-1a, 30 mcg should be reported.

    Patients may self-inject only if their physician determines that it is appropriate and with medical
    follow-up, as necessary, after proper training in intramuscular injection technique
    Sandy Stevens, CPC, CPMA

Similar Threads

  1. RAC audit
    By Jamie Dezenzo in forum Medicare Regulations
    Replies: 0
    Last Post: 07-24-2013, 09:55 AM
  2. 2009 RAC audit question
    By tbunch in forum Cardiology
    Replies: 2
    Last Post: 01-12-2012, 05:01 PM
  3. RAC Audit
    By Revenuecycle in forum Compliance General Discussion
    Replies: 1
    Last Post: 12-29-2010, 12:36 PM
  4. Anyone gone through a RAC audit ??
    By Orthocoderpgu in forum E/M
    Replies: 0
    Last Post: 08-30-2010, 01:26 PM
  5. Rac audit experiences
    By Claire Bartkewicz COC in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-30-2009, 02:27 PM

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?

Login

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.