Wiki injection code

[susan.umble]

Pt was seen in dermatology office for a rash. The visit was coded 99213 with a dx code 782.1, using a 25 modifier. He had a 11100 with a 238.2 dx, using a 59 modifier. He also received a kenalog injection J3301 and an injection code 96372 with a dx code of 698.9. Medicare paid everything but the injection code. The 96372 code was denied stating that a qualifying service be received and covered. I am not sure what that means and if there is anything I can do to get the injection code paid for. I appreciate any input.

 

[normae24]

Theraputic INJ

I work in family practice and we do not bill therapeutic administration to Medicare 96372, they state that it is inclusive to office visit. When it does go out accidently they bundle the claim and only reimburse us the lesser charge for 96372. Doesn't answer your question but that is how Medicare processes our 96372 billed with office visit. (we do bill it when pt only seen medical assistant no E&M code)

 

[rcrosse]

Injection

We are a Urology office, we bill Medicare 96372 and are getting reimbursed for it. It sounds like your injection code and drug code got separated. Have you tried a redetermination request with the two codes together?

 

[OCD_coder]

The 96372 bundles with the 11100, so if the kenalog injection was performed for a different "lesion", a modifier 59 (new XS) modifier would be needed to separate the work performed.

You did great by linking different diagnosis to the services it appears.