Medical Billing Coding - 96372 & an E&M code, cpt, codes
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Thread Topic: 96372 & an E&M code
Topic Originator: jana
Post Date December 3, 2010 @ 1:50 PM
96372 & an E&M code

December 3, 2010 @ 1:50 PM Reply  |  Email Friend   |  |Print  |  Top

Can you bill 96372 if you are already billing an E&M code with the same diagnosis?  Do the insurance companies pay for it (ie. Medicare)?

Nick R
December 8, 2010 @ 2:44 PM Reply  |  Email Friend   |  |Print  |  Top

No they don't. The billing of a 96372 (formerly 90772) and any E&M Service code is strictly prohibited. The clinical admin/inj fee is "included" in the CPT and visit time with the Physician or Non-physician.

December 8, 2010 @ 4:02 PM Reply  |  Email Friend   |  |Print  |  Top

Thanks Nick, that's what I thought and had been doing, but someone told me that it is billable separately.  It didn't sound right to me.

December 15, 2010 @ 6:29 PM Reply  |  Email Friend   |  |Print  |  Top

we bill these codes on same date of service all the time to Medicare and commercial insurances. You have to bill the E/M code with modifier 25, the drug being injected and then 96372.

December 17, 2010 @ 10:32 AM Reply  |  Email Friend   |  |Print  |  Top

According to our MAC (PA/NJ/Del) You can certainly bill an E & M and a therapeutic injection (with -25) IF the documentation meets the requirements.  The injection needs to be a result of the history and exam and for treatment of the condition.    If the problem was previously evaluated and the patient is here just for the injection, then you cannot bill an E & M in addition.

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