Wiki Can anyone share some clarify 99211 vs 98960

[meld]

A patient with testosterone deficiency comes to our office for injections. After a few visits, our nurse educates him how to self administer the testosterone injection. Can we submit the nurse's time as an education visit with CPT code 99211, or 98960?

 

[jvilla]

I would only submit for the injection.

Codes 96365-96379 hit NCCI edits with 99211. This can be overwritten with a modifier, however unless your nurse was educating the patient on something more than the self-injection, for the same substance previously administered (same DOS), then it would be inappropriate to override this relationship with a modifier 25.

So, no 99211.

Regarding 98960: It may be necessary to research your local MAC regarding this code, for example, for Noridian, Jurisdiction E, states that "CPT codes 98960-98962 are not separately billable services. They are bundled into another service, like an E/M."
(https://med.noridianmedicare.com/web/jeb/education/act/act-qa-012016)

Also, when looking up 98960 on CMS MPFS look-up tool, there is no pricing available; I don't believe CMS covers this code at all (assuming that this is the payer you're dealing with)
(https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx)

I would go with just 96372 + (Substance) assuming all documented and POS criteria are appropriate.

You may be able to bill 99211 for your nurse if no other service was rendered, in conjunction with the time spent on education, on the same DOS.

Here is some additional information on 99211 from the American Academy of Family Physicians:
(http://www.aafp.org/fpm/2000/0700/p39.html)

I hope this helps.