Wiki 90471 90472 Administration Code Use

[fmoore66]

Hello,
I just started with a clinic group who provides vaccines from the state and also vaccines brought in from the patient. So we can't bill for the drug itself.
My question is? They are wanting to submit a administration code to the payor with out the CPT code of that particular drug that the administration is being used for.

Is there a particular case where we can submit a administration code of a drug that we are not providing for the patient?

Example: We get Bicillin from the state in which we were using the SL modifier, so we were billing the administration codes for bicillin but billing a penny for the drug it self.

Now they are wanting to not add the code for the drug and just bill out the administration code. But how woudl we bill a administration code and not show what the admin code is for.

Please help!
Thank you in advance.

 

[ELAINEH]

In my office we bill for Botox injections for anal fissures. The medication is sent to our office from the patient's pharmacy and will bill for the administration of it and the the J code for the Botox with NC (for no charge) modifier and have no issues.

 

[CBLENNIE]

Not all carriers require a code be submitted for the vaccine that is being administered. The insurance company I work for accepts claims for admin codes to be billed without a corresponding vaccine code. You are probably going to need to figure out the requirements for billing for each insurance company you are submitting claims to, or at least those you are contracted with.

 

[CBLENNIE]

Hi. Try using CPT 96372

@Michael0630 are you recommending using 96372 to bill for administration of a vaccine? If so, it is inappropriate to bill 96372 for this type of service.

Per Encoder Pro the excludes notes specifically state not to use it for administration of vaccines/toxoids.


If you are responding to @ELAINEH and her question regarding Botox, the code for administering Botox is going to depend on where & why the medication is being administered. A good place to start on trying to figure out what administration code would be appropriate to bill for Botox is the CMS Billing & Coding article on this subject. A57185-Billing and Coding: Botulinum Toxin Types A and B Policy.

 

[CBLENNIE]

In my office we bill for Botox injections for anal fissures. The medication is sent to our office from the patient's pharmacy and will bill for the administration of it and the the J code for the Botox with NC (for no charge) modifier and have no issues.

Hi @ELAINEH , here is the link to CMS Article A57185-Billing and Coding: Botulinum Toxin Types A and B Policy, which addresses the coding for administering Botox for Anal Fissures.