Imagine that you submit a claim for a specific CPT injection code, but it is refused or rejected. That is a very common phenomenon. Wouldn’t you be disappointed, especially if you had no idea why you had been rejected?
So, what are your options? The next step would be to resubmit the claim line for processing with the right qualification, however, the reopening procedure is not required.
Identifying CPT Code 96372
According to the American Medical Association’s Current Procedural Terminology (CPT) code 96372 is a medical practice that falls into the category of Targeted therapy, Prophylactic, and Diagnostic Injections and Infusions (Excludes chemotherapy and other massively complicated drug or extremely complex pharmacologic agent management); highly efficacious or intramuscular.
Reimbursement Criteria for CPT Code 96372
The main goal of a 96372 CPT Code injection is to provide a minimal amount of medication in a single dose. Subcutaneous (sub-Q), intramuscular (IM), or intra-arterial (IA) injections are used instead of an intravenous (IV) injection, which demands an investment of time. Reimbursement for the 96372 CPT code is allowed when the injection is performed alone or in conjunction with other procedures/services that are approved by NCCI.
Separate reimbursement will not be allowed for CPT code 96372 when billed in combination with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same date of service, separate reimbursement will not be authorized. If a patient-supplied drug is being given, the same medication, as well as the dosage, must be noted on the CMS-1500 Box 19 or the 837P’s equivalent loop and segment. 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 medication along with the dosage must be entered on the medical billing denials Box 19 or the equivalent loop and segment of the 837P.
When billing for specific procedures, the medical provider must be aware of the CPT codes to use. In some circumstances, a modifier for the procedure code should be provided, and it should be compatible with the CPT code. The payer may issue Denial Code CO4 if the modifiers are incorrect or missing; this is one of the most common reasons for medical billing denials.
Causes for CPT code 96372 denials
According to the American Medical Association’s (AMA) Current Procedural Terminology (CPT) and the Centers for Medicare and Medicaid Services (CMS) guidelines, the following are the reasons why CPT code 96372 is rejected.
- CPT code 96372 is not correctly recorded, showing that a treatment or service was different or unique from other operations done on the same day.
- The physician reports CPT code 96372 in an institutional environment.
- Procedural code 96372 is conducted in a non-facility set – up by some other medical professional, besides the physician or other competent healthcare providers, without close supervision for any of the reasons for health assessment, permission requirement, security supervision, and based on inter monitoring of employees. CPT number 99211 would be acceptable for reporting this type of situation.
- A comprehensive evaluation of the client is already included in procedure code 96372.
- You are not permitted to charge for the same service twice. If given an extra E/M service parallel to the injection, you could trust both the injection and an E/M code at the same appointment. This E/M service would need to be adequately described.
- You could not bill for the same treatment if the necessity for the injection was previously determined during the prior appointment (billed as an E/M code).
- CPT code 96372 is assigned to specific types of vaccines. The majority of vaccines are generally classified as 90471 or 90472. G0008 is the Medicare administrative code for flu vaccines.
- Injections linked to the delivery of chemotherapy treatments are invoiced using procedure code 96372. The correct CPT code is 96401-96402.
Billing and coding procedures can be time-consuming, it may not be cost-effective or strategic to handle these processes in-house. Moreover, the industry is evolving at an unprecedented rate, making it challenging for health providers to keep up with ever-changing medical billing rules and regulations.
Outsourcing your medical billing and coding is one of the most effective methods to make your billing process efficient and increase patient satisfaction. Zee Medical billing provides medical billing services that ensure on-time and accurate billing. We realize the importance of providing accurate information to avoid delays or denials from the insurance company. Our staff is trained in medical and coding procedures such as patient demographics, CPT and ICD code modifiers, and so on.
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