Pediatric Coding Alert

Question: One of our pediatric patients reports for an Enbrel shot weekly. The parents refuse to administer the shot themselves at home. The medication is shipped to the family directly and they bring it in for our nurse to administer. My question is, do we only bill for a nurse visit (99211), or can we also bill for an injection code of CPT 96372 even if we did not supply the drug? Also, is it a liability for us to administer a drug to a patient without knowing the care of the drug before we receive it?

Michigan Subscriber

Answer: If your staff member is administering the shot, you can report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection. Do not bill the insurer for the drug itself since your practice did not pay for it. Code 99211 would only be appropriate if a medicallynecessary

E/M service was provided by the nurse. For example, if the patient had a URI and the nurse assessed it and made management recommendations. Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be attached to 99211, and careful documentation is a must.

If you are concerned about liability, arrange to have the medication shipped directly to your pediatric office going forward. Therefore, you can verity that it was stored properly and handled appropriately.