Neurology & Pain Management Coding Alert

Question: Our provider split a vial of medication and administered it to the patient at two different sites. We know to submit CPT 96372 for the injection. How do we handle everything else -- with modifiers, two administration codes?

Missouri Subscriber

Answer: You can report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for each individual injection because your provider administered the medication to two distinct sites. How you list the injections on the claim depends on the exact situation.

Scenario 1: If the provider performed both injections for the same reason (that is, linked to the same diagnosis code), report the injections as a single line item with two units of service.

Scenario 2: If the provider administers injections of the same drug at different anatomic locations for different diagnoses (different ICD-9 codes), report the injection codes on separate line items so that each 96372 cam be linked to the appropriate primary ICD-9 code. Append a modifier to indicate that the second line item is not a duplicate. Don't choose modifier 51 (Multiple procedures) since 96372 carries a "0" multiple procedure discount indicator or "0=No payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure, base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure." Many payers direct providers to append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) in this type of scenario.

Medication: Most payers allow providers to report the total amount of the same drug injected on the same date of service to the same patient on a single line item. The units of service should equal the total amount of drug injected. For example, if a provider for some reason wanted to split the 60 mg of ketorolac into two separate injections, the provider could bill the drug as a single line item of J1885 (Injection, ketorolac tromethamine, per 15 mg) and four units of service.

Caveat: An exception may be some payers want you to bill the hyaluronan medications, J7321-J7325, separated into two line items if the provider injects separate joints(such as the patient's right and left knees). Billing this way would allow the payer to potentially keep track of how many doses the patient has received.