Pulmonology Coding Alert

Question: A nurse at our facility recently provided an injection to one of our patients. We billed 96372 along with 99211. Our claim was denied. Can you tell us what codes we should report for the services provided by our nurse to the patient?

California Subscriber

Answer: Answer: You cannot code an E/M service along with the injection services provided by your nurse. As per the Correct Coding Initiative (CCI) edits, 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 a column 2 code for 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) with the modifier '0' that means that these two codes cannot be reported together under any circumstances.

If a supervising provider was present in the office when your nurse administered the injection, you can report 96732. If there was no supervising provider when your nurse provided the injection, you should not report the service. You should interpret "supervising provider" to mean any qualified supervising care giver who can bill in their own right. This rule would only apply when a registered nurse (RN) is giving the injection, not the physician, nurse practitioner (NP), physician assistant (PA) or certified nurse midwife (CNM).

However, you will also incur another problem if the RN gives the injection and you have no one who can supervise or is qualified to supervise if something goes wrong (called malpractice risk).