# 96372



## wynonna (Jun 14, 2018)

Are insurance companies reimbursing for 96372 with J codes (medications such as Kenalog and Rocephin) when done with an office visit?
thank you


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## perrinl@upstate.edu (Mar 12, 2019)

*HElp!!!!Also have the same questions*

We always bill the e/m and 96372 for admin in professional setting, the hospital we are affiliated charges for the drug.... however they are now requiring we also bill the "J" code.  In our setting we never bill for drugs just the professional service provided?  should we be billing both J code and 96372???


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## Chelle-Lynn (Mar 12, 2019)

When the medical records supports the billing of and E&M code along with a 96372, and J-code; we do bill for all three codes and receive payment.  An Example would be:


The patient presented for an injection to their knee with kenalog due to on-going knee pain
While in the office the patients was also seen for acute cold symptoms and a treatment plan was documented
The documentation for the cold symptoms and treatment supported a 99213 separate from the injection

We would bill:

99213-25
96372
J3301


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## Tgarner2016 (Apr 10, 2019)

We are having issues with code 96372 being paid. Has anyone else had this issue. Medicare/BCBS will pay on certain claims but then turn around and deny stating "This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements." We billed an office visit with modifier 25 along with j0696 and j1100. Everyone other claim that pays also includes an office visit with a modifier 25 and usually the same injections.


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## cjamieson@me.com (Apr 10, 2019)

*B-12 and Testosterone injecdtions*

We've recently been having serious issues getting claims paid where a patient brings in their own medication for injections. We have always just billed a 96372 by itself, but recently they've been rejected for not having any J codes on the claim. We don't put them on because we feel we shouldn't charge insurance for an injection the patient provided, has anyone else had this issue?


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## mitchellde (Apr 10, 2019)

The Medical necessity for coverage of an injection is tied to the medication not the administration.  If the medication is covered the admin is also covered and if the medication is not covered then the admin is not either.  So if the patient brings in their own meds you use the J code for the medication but you use a $0 charge or a $0.01.


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## cjamieson@me.com (Apr 10, 2019)

Thanks as always Debra!


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## cjamieson@me.com (Apr 10, 2019)

*Follow up 96372 w/o office visit*

Hey, thanks for the help earlier. I wanted to clarify, these patients bring in their medication and we have only billed the 96372, no J code no E&M. I’m thinking we need to be billing a low level office visit, like 99201/99211. What are your thoughts?


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