Wiki Billing E&M with 96372

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jcruz

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A question has come up regarding billing an E&M at the same time that you are billing an injection admin code. If a patient comes in for a sore throat, is diagnosed with strep and given a shot of rocephin, can you bill the 99213, 96372 and the J code, using a 25 modifier on the E&M?
 
Yes, as long as document support an E&M level, and the injection documentation consist of location on body, route, drug, some sort of order from the physician for the injection.
 
Yes. You can also code the 87880 for the Rapid Strep screen if the provider does one. I have seen in some cases where we have gotten denials bundling the 87880 to the 96372 however we have been successful in getting a corrected claim paid if we append the 59 modifier to the 87880. Good luck!
 
I thought mod 59 was not to be used. When we give rocephin we have the pt go pick it up at the drug store. Bill the EM with mod 25. Then 96372 and bill the drug with 0 dollars because the pt brought it. You only get reimbursed like .46 cents for 250mg of rocephin and it cost a lot more to purchase it.
 
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