Forum - Questions & Answers

Sep 27th, 2016 - Jhiggins11 1 

Billing nurse visit with injection

I am with a Nurse Practitioner and she has raised a question. I keep getting conflicting information. She provides allergy injections and various other injections for some patients. When those patients come in, she is in the building, she has her nurse check and record all vital signs and talk with the patient before providing the injection. We have been billing a 99211-25 for the monitoring of the vitals and then a 95115 for the allergy injection. Then some patients come in for a Rocephin injection, the nurse runs through the whole check in and documentation process with them as well prior to injection. We then bill 99211-25 for the vitals, with the J0696 for medication and 96372 for the administration. Are these correct ways to bill?

Sep 28th, 2016 - NewGenerationBilling 1 

re: Billing nurse visit with injection

If you use the 99211, the insurance will apply a copay. If you use the 96372, the allowed amount is generally higher and the insurance doesn't apply a copay.

Most insurances will not allow a 99211 and a 96372 on the same day. So, you can bill them, but they end up getting bundled and the insurance likes to pay the one with the lowest allowed amount. You will end up getting more money if you bill just the J0696 and the 96372.

Sep 29th, 2016 - Jhiggins11 1 

re: Billing nurse visit with injection

Even with a 25 modifier on the visit, since it is separate from the injection and administration?

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