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Basics of CPT 96372
The primary intent of an injection as described by 96372 is generally to deliver a small volume of medication in a single shot. The substance is given directly by subcutaneous (sub-Q), intramuscular (IM), or intra-arterial (IA) routes, as opposed to an intravenous (IV) injection/push that requires a commitment of time. 96372 CPT code reimbursement is allowed when the injection is performed alone or in conjunction with other procedures/services as allowed by NCCI.
Separate reimbursement will not be allowed for CPT code 96372 when billed in conjunction with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same date of service. If a patient supplied medication is being administered, the same of the medication along with the dosage must be entered on the CMS-1500 Box 19 or the equivalent loop and segment of the 837P.
Reimbursement Guidelines for CPT 96372
Across the country, in offices and facilities, coders are having trouble with CPT® 96372 Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular. As this code is applied incorrectly, providers are not being paid for this injection administration code.
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CPT codes 96372-96379 are not intended to be reported by the physician in the facility setting. Thus, when an E/M service and a therapeutic and diagnostic Injection service are submitted with CMS Place of Service (POS) codes 19, 21, 22, 23, 24, 26, 51, 52, and 61 for the same patient by the Same Individual Physician or Other Qualified Health Care Professional on the same date of service, only the E/M service will be reimbursed and the therapeutic and diagnostic Injection(s) is not separately reimbursed, regardless of whether a modifier is reported with the Injection(s).
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E/M services provided in a non-facility setting are considered an inherent component for providing an Injection service. If a significant, separately identifiable EM service is performed unrelated to the physician work (Injection preparation and disposal, patient assessment, provision of consent, safety oversight, supervision of staff, etc.) required for the Injection service, Modifier 25 may be reported for the EM service in addition to 96372-96379.
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E/M service code 99211 will not be reimbursed when submitted with a diagnostic or therapeutic Injection code, with or without Modifier 25. This very low service level code does not meet the requirement for ‘significant’ as defined by CPT, and therefore should not be submitted in addition to the procedure code for the Injection.
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The Preventive Medicine codes (99381-99412, 99429) do not need Modifier 25 to indicate a significant, separately identifiable service when reported in addition to the diagnostic and therapeutic Injection service. The Preventive Medicine codes include routine services such as the ordering of immunizations or diagnostic procedures. The performance of these services is to be reported in addition to the Preventive Medicine E/M code. Therefore, diagnostic and therapeutic Injections can be reported at the same time as a Preventive Medicine code without appending Modifier 25.
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When an E/M service and an Injection or Infusion service are submitted for the same enrollee on the same date of service, there is a presumption that the E/M service is part of the procedure unless the physician identifies the E/M service as a separately identifiable service.
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You will separately reimburse the same physician for both an Injection procedure and E/M service on the same date of service if each is performed in a different place of service (POS) and the Injection was provided in a POS other than 19, 21, 22, 23, 24, 26, 51, 52, and 61. For example, if the patient only receives an Injection at a physician's office (POS 11) and later that day the patient is admitted to the hospital (POS 21), both services, the Injection service performed at the physician's office and the E/M performed later that day at the hospital, would be separately reimbursed.
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When an E/M service and a procedure are submitted for the same enrollee on the same date of service, there is a presumption that the E/M service is part of the procedure unless the physician identifies the E/M service as a separately identifiable service. Since the Injection procedure does not include the components of a Preventive Medicine E/M service, the Injection can be reported separately and the Preventive Medicine E/M code does not need a modifier to indicate it is distinct or separate from the Injection procedure.
Billing and coding tasks can be quite demanding, it may not make much economic and strategic sense to run these operations in-house. In addition, the industry is changing at an unprecedented rate, making it difficult for medical practices to keep up with the ever-changing rules and regulations in medical billing and coding.
Medical Billers and Coders (MBC) provides medical billing and coding services that ensure on-time and accurate billing. We understand the importance of entering the right information so there are no delays or denials on behalf of the insurance provider. To know more about our billing services, you can contact us at 888-357-3226/ info@medicalbillersandcoders.com
Reference:
Injection and Infusion Services Policy, Professional
Published By - Medical Billers and Coders
Published Date - Jan-27-2021
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