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Pediatric Coding Alert

Reader Question:

96372 Applies If Patient Brings Own Meds

Published on Wed Jun 01, 2011

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 SubscriberAnswer: 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 [...]
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