Forum - Questions & Answers

May 10th, 2011 - CarolAnn8

96372 w/ office E/M - Carol

Help..

Where do I find the article/ruling for CMS instructions for billing 96372 with an E/M. Do we have to put a 25 modifier on the E/M always. Also do we have to have separate documentation for an office visit and the injection fee/w Jcode.

Can we always bill the administration fee with the appropriate Jcode with the E/M?

Example 1: Est. Patient being seen due to seasonal allergies. 477.9 dx CPT® 99212, 96372 and J1040. Do I have to have a separate diagnosis and documentation to bill the office visit?

Example 2: Est. Patient returns for f/u. HBP, Diabetes, Hyperlipidemia. Documentation: continue present meds, general exam done. Pt complains of Knee pain and he has generalized tenderness and inflammation. Depomedrol is given.

Thank you.

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May 11th, 2011 -

re: 96372 w/ office E/M - Carol

[Help..

Where do I find the article/ruling for CMS instructions for billing 96372 with an E/M. Do we have to put a 25 modifier on the E/M always. Also do we have to have separate documentation for an office visit and the injection fee/w Jcode.

Can we always bill the administration fee with the appropriate Jcode with the E/M?

Example 1: Est. Patient being seen due to seasonal allergies. 477.9 dx CPT® 99212, 96372 and J1040. Do I have to have a separate diagnosis and documentation to bill the office visit?

Example 2: Est. Patient returns for f/u. HBP, Diabetes, Hyperlipidemia. Documentation: continue present meds, general exam done. Pt complains of Knee pain and he has generalized tenderness and inflammation. Depomedrol is given.

Thank you.]

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May 12th, 2011 - jschmutz   323 

re: 96372 w/ office E/M - Carol

If the E/M is significant and separate from the injection then both the injection and the E/M can be reported (attach 25 mod to E/M). There does not have to be a separate documentation of the office visit and the injection (both the office visit and the procedure can be documented within the same note) but the injection is a procedure and the documentation has to suport the procedure being performed.


 


Example1: Not sure why the injection was done or where the injection was done so I cannot help you with the coding on this one.


 


Example2: You don't state why patient is being seen in f/u so I don't know whether the E/M is separately reportable or not. You state the patient had knee pain and an injection of depomedrol was given. If the injection was to the knee joint then you would report 20610 and J1020, J1030, J1040 depending on the amount of drug given. You would not report 96372.


 


 


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May 12th, 2011 -

re: 96372 w/ office E/M - Carol

Thank you. no there was not a trigger point injection. I was just trying to find out if the administration fee 96372 CPT® code is billiable w/out a modifier on the office visit and why physician note has to be clearly separate procedures in the notes.

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May 13th, 2011 - jschmutz   323 

re: 96372 w/ office E/M - Carol

I'm not sure what you mean about the trigger point injection. I don't recall asking about a trigger point injection. However, I do think you are billing your injections incorrectly based on the information you have provided.

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