Pediatric Coding Alert

Question: If a patient pays for her medicine and goes to our 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?

Answer: You cannot ever bill 99211 with 96372. In fact, according to the Correct Coding Initiative (CCI), no modifier will separate the edit bundling these codes together, so there are no circumstances under which they can be reported together. You have two options:

Option 1: You bill 96372 for the injection as an incident-to service if a supervising provider is present in the office.

Option 2: You bill 99211 instead. This rule would only apply when a registered nurse (RN) is giving the injection, not the pediatrician, nurse practitioner (NP), or physician assistant (PA).