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KristieStokesCPC

KristieStokesCPC

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What is the rule of thumb for the injection administration, 96372? If a patient was given 2 injections of J1100 and J1885; would I bill 96372 w/2 units, two separate charges of 96372 with a 59 modifier, or just one charge for 96372?

Thanks
 
I'm guessing it's the payer discretion? For some reason I've gotten myself so confused on this today.... I think I have short timers with my upcoming vacation :eek:
 
Hi,

If more than one injection billed on same day we can use 59 modifier with second admind code.What about the office visit billed along with injection and admin? Kindly clarify on this.How do we bill for the below scenario.Kindly clarify on this.

99213,J1040,J3420

Thanks
vallikumaran,CPC
 
If the documentation supports that the pt was seen for a significant and separately identifiable encounter then I would do
99213 25
96372
96372 59
J1040
J3420
I do not use units because you did not give 2 units of an injection you gave 2 distinct and separate injuections at 2 separate injection sites.
 
So even if you have 3 injections you would still use mod 59 for other 2 admi ?
In our office we were told you can only bill it once for admin, even if there were more than one injection.

MsMaddy CPC
 
so i will use the administrative code twice and amend modifier 59 on the second code. if this is correct, than you because you just made my day.
 
Last edited:
Kristie, the payer discretion rules can drive one batty. It's a good idea to keep a notebook of each payer's preference as some do accept (want) multiple units such as 96372(2) but I've found the best way is to utilize the 96372, 96372-59 after receiving this advice from Deborah who already has chimed in.. Yes, you may get some denials for "duplicates" (!!!), but that easily rectifiable. I usually write a note in box 19, so when calling on the "dupes", I can point to that and they'll send back for reprocessing. Yes, it's a pain, but part of the business. The art of properly applying modifiers should be a separate and comprehensive component of learning medical billing and coding IMO!!
---Suzanne E. Byrum CPC
 
Internal Medicine Coding, CPC

I was researching myself as I just got denied from Tricare becauase I billed 2 admin codes on the same day. Even though I used 59 modifier on one of them... I have finally got hold of a rep who said that Tricare pays up to 3 drug admin codes on a same day if modifier 59's are used. He just sent it back for reprossesing over the phone.

Just to give you an idea... This is what I billed and I got paid for all line items:

E/M 99213-25
Admin 96372-59
Drug J0696
Admin 96372
Drug J2930

I hope this was helpful.
 
Does 2 units of J1885 = 2 units of 96372?

The note says "Toradol 30mg IM given". J1885 if for 15mg so I am billing 2 units. Does the 96372 also get 2 units?

Thank you in advance for your help.
 
Does it make a difference if two different drugs are injected at the same site? For example, if there were two drugs shot into the right glute, would I still bill 96372 and 96372-59, or just 96372 once?
 
You would bill for how many injections were administered. If meds were mixed into one injection, only one injection would be billed in addition to your J-code for each drug.
 
So if the provider doesn't document that the drugs are mixed, do we assume that they aren't and bill multiple admins?
 
FYI information:
I just listened to a recorded webinar by Cahaba yesterday that stated, identical procedures will be denied if billed on 2 lines with the 2nd procedure applied with a modifier 59. They want these types (96372) procedures billed on one line only with 2 units (or more if documented) and not use the modifier 59. They are considering the 2nd line item to be a duplicate and will automatically deny.

If the documentation specifies two separate IM injections, you should bill with 2 units.
Do not assume that the drug(s) are mixed unless they state, query and find out for sure before sending a claim.
 
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