Wiki Cpt-96372

[wchristensen]

One of my Ortho's is coding 96372 along with THR's and TKR's "in a facility setting". After several denials and research I learned that the facility bills for 96372. My question is..."Can the doc bill for the administration of 96372"? If so, what code would I use? 20610? FYI: the dx is osteoarthritis. Much thanks to who ever answers this!!

Wendy Christensen

 

[btadlock1]

One of my Ortho's is coding 96372 along with THR's and TKR's "in a facility setting". After several denials and research I learned that the facility bills for 96372. My question is..."Can the doc bill for the administration of 96372"? If so, what code would I use? 20610? FYI: the dx is osteoarthritis. Much thanks to who ever answers this!!

Wendy Christensen

96372 is an administration code - If you are billing another procedure (for example, 20610, but it could be any other procedure), 96372 is bundling to the other procedure, and will require a 59 modifier to pay separately. You only bill a 96372 for an intramuscular injection of a therapeutic or prophylactic drug/substance - like if you're giving someone a shot of rocephin. 20610 is for arthocentesis, which I believe actually goes into the joint, so it's not quite the same thing. Your doctor can bill for just about any injection administration that they perform, as long as it was actually done as an individual service, and not as part of a comprehensive procedure package.

Did that make sense? I feel like I rambled there...

 

[wchristensen]

Makes perfect sense...Thanks!!

 

[okathy]

So does this mean in a hospital owned urgent care, we can charge for an E/M w/ mod 25, an IM injection of Rocephin or Toradol & the J code for meds? If more than 1 injection is given, can we charge for each administration?

Thanks a bunch!!!!

 

[mitchellde]

Who gave the injection? Did the physician give it , or did the hospitals clinic nurse give it? In the facility setting the physician cannot charge for procedures performed by the facilities employees