cpt 96372 injection code

[julia9723]

If a patient comes in with a cold and the doctor gives some type of injection related to the cold, would I add the 96372 to the visit. I'm looking at other visits when we have used this code and they pay, but deny the office visit. CCI edit say I could use the 59 modifier, but if it's related to the cold the reason the injection was given, that wouldn.t be a correct use of the 59 modifier. Am I correct?

[mitchellde]

You cannot chose here between the codes. If the visit is for the injection then you must code the injection code you cannot elect to code an office visit because it pays more. If the visit is to evaluate an ill individual and in the course of the evaluation then an injection is administered you may bill the office visit with a 25 modifier and the 96372 with no modifier.
Every procedure including the 96372 has as an inherent part of the procedure the assessment of the patient necessary to complete the procedure. However when documentation supports that the assessment was over above and beyond the procedure then you may bill for both. The reason for past denial may have to do with "trending", payers perform post audits and then based future pay decisions on the results. Post audit has demonstrated an abuse of the 25 modifier, in that documentation does not support its use most of the time. Therefore they pay one or the other, office visit or procedure and sit back and see what your response is. If you do not appeal then you have confirm their suspicion.

[julia9723]

Thank you for answering, the documentation is there, we weren't putting the 25 modifier.

[jeffriesm]

Can I bill 96372 for injection of xylocaine when it is given during a biopsy of the vulva, which was coded as 56605? Thank You

[Leandra]

We do not bill separate admin code for the local anesthetic injection - considered bundled with the procedure.

[mstroman]

I was asked this question today - if one of our md psychiatry residents/students is seeing a patient and giving an injection to a patient can he bill for the injection in addition to billing for the med management (with a 25 modifier)? We don't typically bill for the injection given and I want to give a good reason why we don't if it isn't billable.

You cannot chose here between the codes. If the visit is for the injection then you must code the injection code you cannot elect to code an office visit because it pays more. If the visit is to evaluate an ill individual and in the course of the evaluation then an injection is administered you may bill the office visit with a 25 modifier and the 96372 with no modifier.
Every procedure including the 96372 has as an inherent part of the procedure the assessment of the patient necessary to complete the procedure. However when documentation supports that the assessment was over above and beyond the procedure then you may bill for both. The reason for past denial may have to do with "trending", payers perform post audits and then based future pay decisions on the results. Post audit has demonstrated an abuse of the 25 modifier, in that documentation does not support its use most of the time. Therefore they pay one or the other, office visit or procedure and sit back and see what your response is. If you do not appeal then you have confirm their suspicion.