Wiki Cpt 96372 denial as anesthesia package

[davetsn]

Howdy. Got a problem.

I work for a worker's comp 3 doctor practice.

A patient came in with a finger laceration from a metal cutting tool. It wasn't bad enough to warrant stitches so I coded this as a new office visit 99203. In addition to the laceration, she said she did not know when her last tetanus shot was so we gave it to her (CPT code 90714 for the tetanus and 96372 for the injection. She also got some ibuprofen 400 mg. I then added a -25 modifier to the office visit.

The insurance company paid for the office visit, the 90714 and ibuprofen but is denying the 96372; saying the service represents an include component of the anesthesia package. Service denied.

I have looked in the CPT book and 96372 has nothing to do with a anesthesia package. I have always used 96372 in conjunction with 90714 but do not understand the denial. I have appealed twice and been sent back denied with no additional reimbursement.

Am I doing something wrong?

Thanks

Dave

 

[CodingKing]

96372 is not a vaccine admin code. Yes even though there is an injury its still a vaccine. See CPT parenthetical note:


(For administration of vaccines/toxoids, see 90460, 90461, 90471, 90472)

 

[davetsn]

Thanks. I will check into that.

Dave