Ob-Gyn Coding Alert

Question: If a patient pays for her medicine and goes to the clinic for the nurse to give the injection, we can bill CPT 96372 (Therapeutic, prophylactic or diagnostic injection ...). But CPT says we should bill 99211 (Office or other outpatient visit ...) if this visit takes place without physician supervision. We used to bill an E/M code but stopped when we were told at a coding seminar a few years ago that we could not do this. What should we report?

South Carolina Subscriber

Answer: You cannot ever bill 99211 with 96372. You have two options:

Option 1: You bill 96372 for the injection if a supervising provider is present in the office.

Option 2: You bill 99211 instead if no supervising provider is present in the office. You should interpret "supervising provider" to mean any qualified supervising care giver who can bill in their own right. This rule would only apply when a registered nurse (RN) is giving the injection, not the ob-gyn, nurse practitioner (NP), physician assistant (PA) or certified nurse midwife (CNM).

Heads up: You will also incur another problem if the RN gives the injection and you have no one who can supervise or is qualified to supervise if something goes wrong (called malpractice risk). And if this patient was a Medicare patient and you have no supervision, you should count this visit as a nonbillable event.