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96372 - Medicare (Georgia) keeps rejecting

  1. Default 96372 - Medicare (Georgia) keeps rejecting
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    Medicare (Georgia) keeps rejecting my nurse injection chg. It is giving several reason: missing/incomplete invalid referring provider primary identifier; missing/incomplete/invalid provider name; claim/service lacks info which is needed for adjusdication. Has anyone had this problem?

  2. Default are you billing as nurse?
    this is still a serv provided by your practice and should be billed as doctor who treated patient, my guess on why missing invalid provider and other rejection kinda all go hand in hand when i see them the service does not get billed as nurse because doctor is signing prov on chart. hope this helps

  3. #3
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    We have to use a referring MD here in NH for any blood draws. We use the MD of the practice or in case there are multiple providers, the MD of the day.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4
    Location
    Columbia, MO
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    Yes there is a CMS bulletin regarding this and when a procedure is performed such as an injection done by nursing staff then the ordering physician is the referring provider. You do need to put his name and NPI in the appropriate spots on the claim.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    Seacoast- Dover New Hampshire
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    however 96372 is a medication administration code. Is this a medication that MCR covers? I know on UB -04 you need condtion codes.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
    Location
    Columbia, MO
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    Quote Originally Posted by kbarron View Post
    however 96372 is a medication administration code. Is this a medication that MCR covers? I know on UB -04 you need condtion codes.
    Yes but when you are billing for the nurse to give the injection it is an incident to claim of sorts since you are using the providers NPI as the rendering/supervising when you do that, following the guidance in CR144, you must use the ordering providers name and NPI as the referring provider even if it matches the rendering/supervising.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Seacoast- Dover New Hampshire
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    I verify all nusring visits that use a 99211 as sometimes the MD does not sign the note and there needs to be medical necessity for this code. You would have to see if this is a Medicare covered code any way.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
    Location
    Columbia, MO
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    ?? This is not a 99211 this is for a 96372 injection admin, which is covered by Medicare, it is rejecting for referring provider per the poster. So the answer to her post is yes she needs a referring provider on the claim. I am not sure where you are picking up the 99211. also the medication was apparently not in question.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    Seacoast- Dover New Hampshire
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    Overthinking!. We have a practice that insists when a medication is given, always use 99211.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  10. #10
    Location
    Columbia, MO
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    Quote Originally Posted by kbarron View Post
    Overthinking!. We have a practice that insists when a medication is given, always use 99211.
    You cannot use the 99211 to administer the injection as a code exists for this purpose. There are numerous transmittals that state this.

    Debra A. Mitchell, MSPH, CPC-H

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