Wiki Need validation OR correction to 99211 versus 96372

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ollielooya

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List members, I know this can be a wearisome topic and have enjoyed reading the posts to the ongoing discussion of what is appropriate to bill, but now I've run into a snag and want to make sure this will be billed out correctly. Physician is in the suite and readily available. CPT guidelines have been read and instructions to use 99211 have been noted, but again physcian is readily available. Registered nurse is giving the injection.

Date: xxxxxxx
Title: Enbrel Teaching
Medication: Enbrel

Route: SQ

Injection location: left thigh
PB: xxxxxxx, Pulse: xxx

Notes: Injection site was cleaned w/alcohol prior to injection. Medication was injected w/o complications. A sterile bandage was placed over injection site. Pat. instructed on signs and symptoms of infection and possible site reactions. Pat. left the clinic in stable condition. Pat. will contact clinic should any questions or concerns arise. Patient demonstrated proper injection technique.

I'm thinking that just the injection should be coded along with the medication from this provider based office? And that little sentence, "patient demonstrated proper injection technique" along with "Embrel teaching" makes me wonder if there might be something more?"

Thoughts, or recommendations, anyone?
The forum list members always come through!
 
was this watching the patient and instruction on proper self medication? If so then use 98960 but time will need to be documented to use that code. If the nurse did not give the drug, if time is not documented or it is less than 16 min, then it is a 99211.
 
Hi, Deborah, was hoping you'd see this and respond, but YES, the nurse did give the injection and I would need to ask if a standardized "curriculum" was being followed in order to assign the 98960, so if that be the case, are we still back to the 99211 or would 96372 be a viable option? Thanks for your insight, and hope you see my reply and can supply a follow-up.
 
If the nurse gave the injection then it is just the 96372 plus the J code for the drug. You should have a standardized set of instructions on hand for all such nurse instructions for patient self administration, you can then have it signed by the patient and the nurse and put into the chart that shows the points covered and then you could use the 98960.
 
Been reading all the posts I could find regarding similar issues and saw yours about coding for orthopaedics and utilizing the 98960 with success, but guess my final question would be.....PROVIDING the criteria is met to assign 98960--- would this be IN ADDITION to the 96372? Also, could the medication STILL be billed? Billing = 98960, 96372, J code? Wouldn't one deny as inclusive to the other? Next step will be to call the payers. Sometimes our books are just not that clear on the issues
Thanks for the response and those who are reading and learning!
 
Please know that I deeply appreciate your staying with me on this issue. Will further discuss this billing scenario with the practice and perhaps make a few changes. Thank you, Deborah.
 
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