Wiki Office Visit with B12 injection and 96372

Create Wiki Sort by date
S

swetap

Contributor
Messages
23
Best answers
0
Have been billed Office Visit as patient comes with complaint of Blood Pressure elevated and also needs B12 shot, so we have been billed 99213 (25) + J3420 + 96372. Service was provided by Physician (PCP). Getting denial from Wellcare like office visit is inclusive with 96372. Any help would be great appericiated.


Thanks,
Jignesh
 
0
swetap said:
Have been billed Office Visit as patient comes with complaint of Blood Pressure elevated and also needs B12 shot, so we have been billed 99213 (25) + J3420 + 96372. Service was provided by Physician (PCP). Getting denial from Wellcare like office visit is inclusive with 96372. Any help would be great appericiated.


Thanks,
Jignesh
Click to expand...
The relative value units assigned to CPT codes for injections include an inherent E/M component. Before any procedure is performed, it’s expected the provider will evaluate the patient to ensure the procedure is the appropriate management for the patient’s condition. For example, when a patient arrives for an injection ordered at a previous visit, the provider will ask questions about the patient’s status to ensure the injection is still the correct course of treatment.
As such, to report a separate E/M service, the E/M component must go beyond that which is normally included in an injection service. In other words, the E/M service must meet the definition of modifier 25. Hope this helps!
 
0
Hi
Are the dx codes correct of II0 and E55.9 per medical discussion /ordered for patient from the provider and linked properly to treatment? Did you list the provider as the ordering physician on the claim too? Was the CPT 99213 justified? Just some questions to think about reason got the denial.
I hope this helps
Lady T
 
0
I agree with Rajapandi2019.
There has to be enough documentation to support a significant, separately identifiable evaluation and management (E/M) service.
If you took away all the work & documentation associated with the 96372, was there enough left to support a separate E/M?

https://www.aapc.com/blog/27677-96372-done-right/ (old but concept is still the same)
 
You must log in or register to reply here.
Top