Wiki Therapeutic Injection w/office visit

[mlittle17@hotmail.com]

Code 96372 (administration of therapeutic injection): I was taught that the administration of 'therapeutic' injections was always bundled into the office visit (E/M) code so that all that was billed out was the E/M code and the J code for the drug administered. Is this correct? Or have I been mistrained?

 

[mitchellde]

If the purpose of the visit is to receive the injection then you do not bill a visit level, you bill the injection admin with the J code. If the visit is significant and separately identifiable from the Injection, then you add a 25 modifier to the E&M plus bill the 96372 plus the J code. You can never substitute an E&M for the injection admin.

 

[LEE ANN]

If the purpose of the visit is to receive the injection then you do not bill a visit level, you bill the injection admin with the J code. If the visit is significant and separately identifiable from the Injection, then you add a 25 modifier to the E&M plus bill the 96372 plus the J code. You can never substitute an E&M for the injection admin.

While I agree and understand what you are saying, where in the guidelines is it documented that you can't bill an admin fee and e/m together. Our providers are struggling with this issue. Showing them what modifier 25 says isn't enough.

 

[mitchellde]

When the patient presents just for a planned injection, the assessment of the patient to determine the need for the injection has already been performed in a previous encounter. Also when the injection is all that is performed with no other complaints by the patient, then you cannot perform an assessment that will meet the 25 modifier criteria; that is, significant and separately identifiable from the need for the injection. The only assessment you will have will be that which had already been performed showing the need for the injection or possibly just body systems randomly examined with no patient complaint to drive the exam.