Billing E&M with 96372 administration injection

Hello,

Patient came in for burn on hand. She hadn't had tetanus shot for greater than 10 years. I think the 96372, administration of injection, is included in E&M and should not be billed separately. Should I bill for both with 25 modifier on E&M or just E&M and drug?

re: Billing E&M with 96372 administration injection

96372 is not appropiate for tetanus. 90471 is the correct adm. code. Some payers will allow it with a 25 mod on the visit if you address another problem that day. Medicare will not pay tetanus vaccines.

re: Billing E&M with 96372 administration injection

I bill this very frequently. Use a 25 on the office visit. No modifier is required for the admin or vaccination codes. Again, Medicare will not pay for a tetanus shot.

re: Billing E&M with 96372 administration injection

Medicare does allow a tetanus shot if you have an injury diagnosis. Resource: Internet-only manual, publication 100-02, chapter 15, section 50.4.4.2, Immunizations

re: Billing E&M with 96372 administration injection

Medicare just recently paid a tetanus for me using V03.7 first and 883.0 (open would of finger) secondary.

re: Billing E&M with 96372 administration injection

Administration of a medicine is a separate procedure and is not included in an E/M service performed by a clinician. A nurse service and an injection are not separately reimbursed.