Forum - Questions & Answers

Apr 18th, 2019 - dlstoner512 1 

96372 Billing

There is discussion in our physician group on the appropriate use of 96372. Some offices are using it only when a patient comes in just for an injection (does not see the physician). Some offices use it when the physician sees the patient and orders an injection (billing for the office visit (with a modifier 25), the medication and 96372). Some offices bill the office visit and the medication only. Can someone point me in the right direction for guidelines/articles on the correct coding?

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Apr 24th, 2019 - ChrisW   148  1 

re: 96372 Billing

If you look at the AMA guidelines (found on Find-A-Code on the code information page) you will see there are administration codes specifically for vaccines/toxoids, non-antineoplastic hormonal injection, anti-neoplastic nonhormonal injection, anti-neoplastic hormonal, therefore if the injection was for any of these reasons 96372 would not be appropriate. 96372 does not include injections for allergies these are reported with 95115-95117.

In addition, the guidelines state 96372 is not to be administered without direct physician or other qualified healthcare professional supervision. this code represents the injection only not the medication. Therefore, the medication should be billed in addition with proper coding for the drug code.

If the patient was seen on the same day and the service was performed separately and for a different reason than the E/M, then the use of modifier 25 may be applicable. "25- Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service"

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