Gastroenterology Coding Alert

Question: A patient receives office injections for vitamin B12. She supplies the medicine. Do we need to include the supply code to get CPT 96372 paid?

Alaska Subscriber

Answer: Yes, you need to include the appropriate supply code: J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg). Even though the patient brings her own B-12 supply for injection, you risk getting an automated denial for the administration code (96372, Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) if you fail to include the supply code.

Do not bill the carrier for the drug's cost, or else you become liable for fraud. Enter a charge of $0.01 (since line items with a zero charge may get missed or scrubbed from the claim) to reflect that the drug was given   but no charge is being billed for it.

Error averted: If the reason for the office visit was simply for the injection, do not report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services ...). Medicare and payers that follow the Correct Coding Initiative (CCI) edits always bundle 99211 into 96372 performed on the same day. CCI does not allow a modifier to bypass these bundling edits.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.