Pulmonology Coding Alert

Question: The physician I work for has the nurse routinely give shots such as Rocephin, etc. as needed. How do I bill for those injections?

Montana Subscriber

Answer: Charge 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the administration of the drugs, provided the procedure is eligible for separate payment.

Report the appropriate J code for the drug, provided your office paid for the supply. Pay close attention to the dosage, as some drugs may be per 250 mg, for example, and if the patient is given 500 mg, you will charge for two units. Rocephin is found under J0696 (Injection, ceftriaxone sodium, per 250 mg).

CCI 15.0 bundles 96372 into all office visit codes (99201-99215). A modifier, such as 25, can bypass all edits except for 99211. Only use modifier 25 to report the visit when the patient receives a medically necessary, separately identifiable E/M on the same day as the injection, such as evaluation of the patients underlying condition (for example, pneumonia). Do not report a visit when the purpose of the visit is the injection, and this is the only service the patient receives.

Example: Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) is billed with an injection service. Expect payment only for code 96372 and the separately payable drug, when applicable.