Urology Coding Alert

Question: The urologist administered an injection of a Xyosted sample. We’re billing an E/M code for the encounter. Can we bill for administration of the drug? If not, how should we document the medication if we are not billing for it?

Kentucky Subscriber

Answer: You should report the appropriate medication code with no associated reimbursement value ($0.00) since the drug was a sample and not a separate expense to the office. That will alert the payer that you’re asking for reimbursement only for the administration rather than the drug. Code the administration with 96372 (Therapeutic, prophylactic or diagnostic injection…subcutaneous or intramuscular.).

Keep these points in mind whenever you bill an E/M office code with drug administration:  

• If the intent of the E/M visit is about performing injection procedure only, E&M visit code would not be billed as per coding guidelines. Only the drug code along with drug administration code will be billed in this scenario.
• If during the E/M visit the provider decides administration of an injection is also necessary, then both services can be billed together.