The doctor performed a lumbar ESI, 62311, in addition to 96372 at the same session, same date, office setting. He used the same diagnosis for both and there is not a lot of discussion in the documentation as to why he did the 96372, therapeutic injection, on the same visit (as a matter of fact, I can't really find anything that supports his reasoning to do so). Insurance carrier is Medicare (in NC), and I am thinking that to bill this I would use a modifier 59 on the 96372; however, I am questioning if it is acceptable to even bill the 96372 in the same session without providing burden of proof in the documentation for his reasoning. Any thoughts?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Billing 96372 with 62311
- Thread starter amandamcelrath
- Start date
mitchellde
True Blue
What did the provider inject? What is the diagnosis? What does the note state?
He injected 12 mg Celestone for the lumbar ESI, and 60 mg of Toradol for the therapeutic injection in the buttock. Diagnosis is 724.03, lumbar spinal stenosis with neurogenic claudication; he used this diagnosis on both orders in the chart. He did state the patient has some buttock pain, so I think I can pull out a diagnosis of SI pain to cover the 96372.
mitchellde
True Blue
You cannot code SI pain from a statement of buttock pain. You can find a code for muscle pain or such or take the note back to the provider for more documentation.