# 96372 Therapeutic/prophylactic/diagnostic injection



## monikaelliott (Sep 11, 2013)

Insurance carrier processed claim for this CPT with a copay, patient upset, did not see our provider - only the MA.  Does this code HAVE to be billed with an E/M?  MUST I bill this CPT with an E/M 99211?


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## christinec (Sep 11, 2013)

Nope, 96372 does not have to be billed with a 99211.


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## Pam Brooks (Sep 11, 2013)

You would never bill a therapeutic injection with a 99211.  The patient should not have a copay, either.  Void your 99211, rebill the 96372 with the J code for the med as a corrected claim, and apologize profusely to your patient.  You unbundled this.    The only time you'd bill an E&M with an injection is if the documentation supported a significant and separately identifiable visit but never the 99211.  If they only come in for the shot, skip the E&M.


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## monikaelliott (Sep 11, 2013)

Our claim was billed with 96372 with J1090 and no E/M. The patient received EOB from Aetna stating copay applied due to place of service 11 and called to inform us we "billed incorrectly" per Aetna.  He was so insistant with what was told to him by Aetna, I started to question myself!


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