Wiki 96372 w/Office visit

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Pam Blackford

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My understanding has been that if a patient comes in and is seen for the same problem that they receive an injection for then we can't bill the admin fee along with it. Example:
99213 for cough and acute bronchitis
J0696 Rocephin 1gr
Because injection is given to treat reason patient came in the office, the admin is considered to be part of the office visit.

Example where we can charge it:
99213-25 for hypertention and DM
B12 for Anemia
96372
Patient wasn't being seen for the anemia so we can bill the admin separately.

Does anyone have any input on this? Thanks!
 
We always bill 96372 w/ office visit when injection was given with direct physician/other qualified health care professional; I work at urgent care facility. Hope this help.

Lina Kerr, CPC, CPC-H
 
I work in a family physicians office. The CPT guidelines don't say anything about that the reason for the visit has to be different then the treatment received, only that there has to be a separate and identifiable E/M visit meaning a clear note showing HPI, Exam, Assessment and Plan. Many patients with an acute problem need additional treatment or service, but the primary Dx can be the same. Your patient for instance has acute bronchitis which if the provider did a note showing an E/M service was provided then ordered the rocephin treatment after their assessment of them, bill 99213-25 and 96372. The same would apply for nebulizer treatment etc. If its a follow up and the note is minimal then just code for the admin. I hope that helps.
 
You must use the 25 modifier with the E&M if you documentation supports the use for significan and separately identifiable then it should pay separate
 
We always bill the injection admin (96372) along with the E/M if the patient sees a clinician. We add the -25 modifier to the E/M and only link the appropriate diagnosis code with the injection admin charge.
 
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