Primary Care Coding Alert

Answer: The idea isn’t a good one for two reasons.

First, purely from a coding standpoint, you cannot bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.) with the 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for administering J0897 (Injection, denosumab, 1 mg). Per National Correct Coding Initiative (NCCI), 99211 is a Column 2 code for 96372 edits with a modifier indicator of 0, which means you cannot unbundle them, and Medicare and payers following NCCI edits will not reimburse you for performing both procedures.

But you have another, more compelling, reason for not billing for both services. The medical necessity of performing a significant and separate evaluation and management (E/M) service along with the injection is not supported by the simple act of having the nurse check the patient’s blood pressure, and Medicare and other payers could consider adding a service to benefit your practice in this way to be abusive or fraudulent.