Pediatric Coding Alert

Question: A 16-year-old patient presented for a Depo-Provera injection. She brought the vaccine with her and we administered it at the office. How should we bill for the vaccine administration?

Florida subscriber

Answer: Depo-Provera is not a vaccine--it is a hormone, so you should report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). To make the charge clear to your insurer, you can add a line item on the claim form for the Depo itself, including the dose and NDC number, with a zero charge and a note stating that the patient supplied the medication.

If the staff spends time providing an E/M visit with the patient and documents vitals or how she's tolerating shots as well as a chief complaint (for instance, "The patient presented for ongoing hormone therapy, previously tolerated well") as well as the injection itself, then you may be able to report an office visit too, with modifier 25 appended (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).