# How to bill for injection w/ office visit



## lmeusch@northeasternhealth.org (Aug 21, 2015)

I am having issues with getting paid for injections with an office visit. Here is an example of a visit we were denied the office visit.
Patient came in for allergies.
CPT code 99213 with DX 477.9
CPT code J3301 with DX 477.9
CPT code 96372 with DX 477.9
We were denied the office visit, does anyone know how to bill this out correctly to get paid for the office visit as well as the medication?
Linda


----------



## jamie@beneficialmb.com (Aug 21, 2015)

If there is just one diagnosis for the visit, the 96372 is included in the office visit. You would remove the 96372 and just bill the J code and office visit. Now if there were 2 or more diagnosis codes and the 96372 and J code were different than the primary diagnosis, then you could bill the 9921- with a -25 modifier and the 96372 and J code. Hope I didn't confuse you there.


----------



## JesseL (Aug 21, 2015)

If patient came in for just the injection or scheduled injection, then bill only 96372.  If the patient presented with a new problem that needed a thorough exam, prescriptions, etc and also got an injection, I would bill 99213-25 with 96372


----------



## mitchellde (Aug 21, 2015)

You do not need a different diagnosis to use the 25 modifier with the visit level.  You only need the documentation to support a significant encounter from the injection administration.  You would never bill the E&M code and the Jcode for the drug only.  If you cannot support a significant office encounter then you would bill the injection admin and the J code and not the E&M.  If the drug is not a covered drug then the administration will not be covered either and it will be patient responsibility.


----------

