Primary Care Coding Alert

Answer: When your FP performs administration of an injection, you report it with 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). If your FP provided two injections to the same patient on the same calendar date of service, you will have to report two units of the code. You will have to append the modifier 59 (Distinct procedural service) to the second unit of the code to let the payer know that your clinician provided two injections to the patient.

 

You may report an E/M code in addition to 96372 under the appropriate circumstances. If the E/M service is separate and significant, then you can report an E/M code for the encounter. However, to allow payment for both the codes, you will have to append the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code or else reimbursement for the E/M service will be denied if the payer is following National Correct Coding Initiative edits.

 

Reminder: Don’t forget to report the appropriate J codes for the drugs that were administered. The CPT® code 96372 only covers the administration while reporting the appropriate J codes will cover the expenses in procuring the drugs.