Medical Billing Coding - billing 96372 with 86580, cpt, codes
medical billing and coding forum

BC Advantage Magazine


Billing-Coding.com

(FORUM HOME)

General Medical Billing Forum

New Topic  |  Search

Thread Topic: billing 96372 with 86580
Topic Originator: Theresa
Post Date March 28, 2010 @ 8:07 AM
billing 96372 with 86580


Theresa
March 28, 2010 @ 8:07 AM Reply  |  Email Friend   |  |Print  |  Top

Can anyone tell me what modifier can be used in order to bill the above two codes as unbundled? Code it Right online suggests that modifier 59 can be appended to 96372.  Is this correct?

Paula
March 30, 2010 @ 9:06 AM Reply  |  Email Friend   |  |Print  |  Top

86580 is not billed with any injection code.  It is the only code used for TB Test, that I know of.

Rebecca W
March 30, 2010 @ 2:03 PM Reply  |  Email Friend   |  |Print  |  Top

Code 96372 (RVU: 0.59) is included in 86580 (RVU: 0.19). 96372 (RVU: 0.59) may be unbundled from 86580 (RVU: 0.19) if you can justify the use of an appropriate modifier. If you are unable to justify the use of a modifier, you may only bill 86580 (RVU: 0.19). If you bill both, 96372 (RVU: 0.59) should receive the modifier.
Try Modifier 25

Theresa
March 31, 2010 @ 6:23 AM Reply  |  Email Friend   |  |Print  |  Top

Thank you everyone.  Shana, do you get paid by carriers for 90471 when billed with 86580?

Theresa
March 31, 2010 @ 6:24 AM Reply  |  Email Friend   |  |Print  |  Top

Thank you everyone.  Shana, do you get paid by carriers for 90471 when billed with 86580?

Theresa
March 31, 2010 @ 11:42 AM Reply  |  Email Friend   |  |Print  |  Top

Robin.  I have not billed 90471 with 86580. I usually bill 86580 with 96372 and we've been having a problem getting reimbursed for the 96372. If 90471 works, then that is what I will use from now on. Thank you!

Tracy
April 6, 2010 @ 10:07 AM Reply  |  Email Friend   |  |Print  |  Top

96372 is for theraputic injection. 90471 is for immunizations. A TB test would not fall into either one of these categories. The injection is subdermal and is included in the 86580

shana
April 13, 2010 @ 4:08 PM Reply  |  Email Friend   |  |Print  |  Top

yes never had a problem

Sarah
May 7, 2010 @ 9:31 PM Reply  |  Email Friend   |  |Print  |  Top

Paula and Tracy, you are both correct.  CPT 86580 should not be billed with an administration code.  Even if you bill 90471 or 96372 with a 59 modifier and it passes the claim edits and gets paid, an audit down the line will result in the insurance company recouping that money.  Also, you could not bill either of those 2 codes with a 25 modifier as that modifier specifically states in the description, "E/M service."  It is improper use of modifier 25.

Bonny
July 30, 2010 @ 10:05 AM Reply  |  Email Friend   |  |Print  |  Top

Should the 86580 (TB test) be billed ON THE DATE of service *OR* three days later when it is actually read as neagtive or positive?

Bonny
July 30, 2010 @ 10:05 AM Reply  |  Email Friend   |  |Print  |  Top

Should the 86580 (TB test) be billed ON THE DATE of service *OR* three days later when it is actually read as neagtive or positive?

Bonny
July 30, 2010 @ 10:05 AM Reply  |  Email Friend   |  |Print  |  Top

Should the 86580 (TB test) be billed ON THE DATE of service *OR* three days later when it is actually read as neagtive or positive?

theresa
July 30, 2010 @ 10:11 AM Reply  |  Email Friend   |  |Print  |  Top

date of service

JKing
February 22, 2011 @ 11:39 AM Reply  |  Email Friend   |  |Print  |  Top

NO!  90471 is an Immunization administration code. TB  TEST IS NOT AN IMMUNIZATION.  Furthermore 96372 is for Therapeutic/Diagnostic injection, Subcutaneous or Intramuscular. TB Test is given INTRADERMAL. So it obviously does not fall into this code either.  CODE 86580 IS THE ONLY BILLABLE CODE WHEN PLACING A PPD. THERE ARE NO EXCEPTIONS!! ANY OTHER USE OF CODING OR MODIFIERS IS INCORRECT!!

Dagmar
October 5, 2011 @ 12:03 PM Reply  |  Email Friend   |  |Print  |  Top

I always billed 86580 with 90471 or 96372 and was always paid. 86580 is only the medication injected for testing, so of course you should get paid for the nurse or Dr injecting it. But lately I receive denials from Medicare for the injection codes? I guess I w/o now because I can't find anywhere how to bill correctly to Medicare, other insurances pay for both codes.

Bianca
January 25, 2012 @ 2:02 PM Reply  |  Email Friend   |  |Print  |  Top

Code 86580 (TB intradermal test) should not be billed with immunization administration codes: 90460, 90461, 90471, 90472.

CPT code for the testing (86580) includes administering of the PPD

karen
January 12, 2015 @ 12:36 PM Reply  |  Email Friend   |  |Print  |  Top

If it was paid-96372 or 90471, etc with 86580, it was paid in error. Follow the CPT coding guidelines as written. CPT code 86580 is in the lab/pathology section. It is not an immunization or vaccine. CPT code 85680 is a global service and includes both the administration and interpretation. It cannot be billed with 96372, 90460, 90471, etc. Also do not bill 99211 for the interpretation. Again, this is unbundling of the service.

Erin
July 15, 2015 @ 3:10 PM Reply  |  Email Friend   |  |Print  |  Top

Thank you so much :D

skpasha
February 9, 2016 @ 1:30 AM Reply  |  Email Friend   |  |Print  |  Top

yes it was correct we have to append the 59 modifier

Debbie Gordon
June 7, 2016 @ 12:25 PM Reply  |  Email Friend   |  |Print  |  Top

What about billing for the medication, Tubersol?

carmen
June 9, 2016 @ 3:04 PM Reply  |  Email Friend   |  |Print  |  Top

86580 does not have a administrator code it is all included .

Gayle
June 10, 2016 @ 5:59 AM Reply  |  Email Friend   |  |Print  |  Top

Modifier 25 only goes on E/M codes.

ud
July 11, 2017 @ 2:31 PM Reply  |  Email Friend   |  |Print  |  Top

Just checking to see if you got an answer. I haven't been able to find how to bill for the medication as the reimbursed amount for 86580 would be for admin/read. thanks.

Robin
March 31, 2010 @ 11:28 AM Reply  |  Email Friend   |  |Print  |  Top

Theresa, may I inquire about the billing of both 86580, and 90471?  Are you being edited by the Carrier on this code combination?  I do not see that there is a published edit that would cause a conflict for the two different services.

shana
March 30, 2010 @ 2:44 PM Reply  |  Email Friend   |  |Print  |  Top

if you bill 86580 you can bill 90471



Copyright © 2008 Billing-Coding Inc