Wiki 99211 vs 96372

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mjbcpc

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I am having the worst time with these two codes. One of our patients is demanding we rebill her Makena injections as 99211 instead of the normal 96372. We are having a tough time trying to determine if this would be a proper code for a Makena injection. We called her insurance and they said it would be fine to charge a 99211, but I'm still on the fence about it personally.. Any suggestions?
 
this is an IM injection so the administration must be coded with the 96372. You cannot substitute one code for another. The payer is also not allowed to tell you how to correctly and compliantly code a claim. Bill it correctly with 96372. But why would the patient request this so specifically?
 
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She had looked up the coding guidelines for Makena on their website, and she was dead set on that 99211 code. Thanks for the response! :)
 
I agree with Debra. Remember, sometimes as coders we don't agree with the revenue side of the business. I happen to do both so I can fuss at myself (lol).

However, in this case .....you would need to bill for the administration and the injection with the applicable units. Tell your patient she needs to call her insurance and discuss what her family planning benefits are. It seems like she probably thought they would be preventative and not subject to the copay and deductibles.,....Not every plan is the same.

Whatever you do....don't change the code to make your patient happy. Our job isn't to make people happy, its to keep the physicians money in their pocket.
 
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