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Pediatric Coding Alert

Reader Question:

Differentiate Vaccine From Other Injections

Published on Mon Sep 03, 2012

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 subscriberAnswer: 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 [...]
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