ED Coding and Reimbursement Alert

Question: Thank you for your article last month about spring allergy coding. We have a follow-up question. We do report 96372 as you advised for epinephrine injections, but we have gotten denials when we report this code with E/M visits. What can we do in this situation?

Codify Subscriber

Answer: Before billing a procedure – such as an injection like 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) – with an E/M code, you should check the Correct Coding Initiative (CCI) to see if there is an edit involved in the two codes.

Once you consult those edits, you’ll see that 96372 is a column two code for the ED E/M codes (99281-99285). A modifier (such as 59 or 25), can be used to separate the edits, but you must ensure that you have the documentation to support the medical necessity of both services.