Practice Management Alert

Question: Our practice is having trouble billing the new codes for 2009, in particular CPT 96372 in place of 90772. We have had two insurance companies tell us that they did not know about the new code, and now those charges are being denied. What should we do?

Illinois Subscriber

Answer: You should appeal these denials. Unfortunately, some private insurance companies do not update their systems with the updated CPT Codes by January 1. This, of course, results in inappropriate denials.

According to the Health Insurance Portability and Accountability Act (HIPAA), payers can only use one set of transaction codes. As of Jan. 1, 2009 that set should be the CPT 2009 set. Your payer needs to be paying or denying your based on the current codeset.

Reporting the injection administration with the 2008 version 90772 should trigger an invalid code rejection, but 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) should be a valid code. This improper denial is delaying approximately $21 in pay per claim for your practice. (Figure based on the 2009 Medicare Physician Fee Schedule assigning 0.58 transitional non-facility total relative value units [RVUs] to 96372 and using a conversion factor of 36.0666.)

Bottom line: Code 96372 is the proper code to use in place of 90772 this year for injections such as Decadron, vitamin B12, or Benadryl.