Wiki 99211 , 96372 coding when patient brings his own Testosterone Medication

[tera828@yahoo.com]

I work for a Urology Practice. The patient brings his own medication for Testosterone. We are questioning coding for 99211 &/or96372. The nurse is injecting medication the patient brings to office. In the Office note signed by the MD it is documented as there is HPI, PQRI, Allergies, Medication list, Vitals, Educational Handouts, and Provider gives plan for return appointment for continued Testosterone injections.

Do we bill Nurse visit 99211 with modifier 25 and 96372, 99211 only , or 96372 only? Again we are not billing any medications.

 

[SharonCollachi]

When the MD sees the patient and writes up the plan as you have listed, you bill the office visit. Insurance may not cover an injection for a self-injectable medication (in fact, I don't know of any that do, but then again, I don't even try to bill it, so take that for what it's worth). You cannot teach him or a family member how to do this?

Most insurance won't pay an injection code unless you indicate what drug it is, even if it is patient-supplied. So the fact that it is testosterone may cause the whole thing to deny.

I do have a patient who literally has no one to do this for him, and he comes in and the medical assistant gives the injection. We don't charge, we do it as a courtesy. Maybe it would be different it we were doing hundreds of them, but for this, no charge.

 

[thomas7331]

If you are performing the injection and the physician did not actually perform a separate face-to-face encounter, you can only bill 96372 for the service. If the payer requires the drug code in order to reimburse the injection procedure, you can report the HCPCS code for the testosterone with a $0 or $0.01 charge so that the payer can determine whether or not the service is a covered benefit.

You cannot bill 99211 in this situation because it is considered an incidental service to 96372 under NCCI rules and no modifier is allowed to unbundle it. It will still deny even if you add the 25 modifier.

 

[jlevitt@urologyslo.com]

we bill for the medication and put as a 0 $ charge then the 96372 and most insurances are paying the 96372 as lon gas the J code for the testosterone has the correct NDC code also.