Wiki Injection charge

[bill2doc]

I think I know the answer but would love if someone would confirm

Debate:

Patient comes in office, sees the nurse for a testo injection and charges the pt an office visit and $30 co-pay

Week later pt comes in sees non credentialed office employee, gets shot and gets charged office visit and $30 co-pay

Can either of these scenarios warrant a 99213 charge and collection of $30 co-pay?

I thought it was face to face w/ physician only!

Thanks

 

[bwolfe1]

I thought you could only use 99211 for a non-physician E/M service. And as far as the co-payment, that is determined by the patient's insurance plan.

 

[Donna T]

No, you cannot bill a 99213 for the visit and you also cannot collect a copay. You can bill for the drug and administration and that is all.

 

[mitchellde]

I thought you could only use 99211 for a non-physician E/M service. And as far as the co-payment, that is determined by the patient's insurance plan.

You cannot use a 99211 for the administration of an injection you can only code the injection admin such as 96372 with the J code for the drug.

 

[Naveen Rachagolla]

CPT says (Physicians do not report 96372 for injections given without direct physician supervision. to report use 99211. Hospitals may report 96372 when the physician is not present. now the answer for your question depends on where the services are provided. along with the admin code J code shuld be there for injection.

 

[mitchellde]

I realize this is what the CPT book states however Medicare rule which is the gold standard states that you cannot use 99211 to give an inject. Also if the physician is not present in the office you cannot bill the 99211 anyway as you must have a supervising physician for the nurse to give in the injection in a physician office setting. Therefore it truely does not depend on the setting, when an injection is given, the injection admin code must be used.