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Tag Archives: 96372

99214, 99406, 90472, 96372

Posted on by
Hi All

Can someone please explain to me how to bill for the following on the same day.

99214
99406
90472
96372

When I append the 25 modifier, I get the following:

The Diagnosis Code(s) submitted with the Procedure Code (99406) does not meet or may not fully support Medical Necessity.
Code 99406 is a component of code 90472 but a modifier is allowed on 99406.
The Procedure Code (90472) is defined as an add-on code.
The Procedure Code (90472) is invalid or requires a parent that is not on the claim.

The patient is in his 40s so I’m confused what the last line means.

Thank you again!

Medical Billing and Coding Forum

billing 59025 fetal stress test with 96372

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Patient was in the office for a fetal stress test 59025 and she also received her injection of Makena 96372. We only bill for the administration of the medication patient brings in. I keep getting rejections from Blue Cross Complete that payment is included in the other billed service 5025. We do not bill a J or Q code for the medication with a 0 dollar amount. I don’t know if that will fix the problem or not. using a 59 or 51 doesn’t work. looking for some direction

Medical Billing and Coding Forum

Reporting Multiple Injections 96372

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When billing for professional services, you should report 96372 Therapuetic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular for each medically appropriate injection provided, as instructed in CPT Assistant (May 2010; Volume 20: Issue 5): Question: What is the appropriate CPT code to report when a patient receives two or three intramuscular […]
AAPC Knowledge Center

Billing 96372 and a 90460 on same claim

Posted on by
I billed an E&M and an injection. Pt also receive a vaccine. It went like this: 99214 w/25 Mod, J1885, 96372, 90715, 90460 w/59 mod. Ins denied 96372 saying it was incidental to 90460 though it had a 59 modifier. Ins says the denial is based on Mckesson Clear Claim guidelines. What the heck is that?! Can anyone tell me where I went wrong?

Medical Billing and Coding Forum

Cpt 96372 denial as anesthesia package

Posted on by
Howdy. Got a problem.

I work for a worker’s comp 3 doctor practice.

A patient came in with a finger laceration from a metal cutting tool. It wasn’t bad enough to warrant stitches so I coded this as a new office visit 99203. In addition to the laceration, she said she did not know when her last tetanus shot was so we gave it to her (CPT code 90714 for the tetanus and 96372 for the injection. She also got some ibuprofen 400 mg. I then added a -25 modifier to the office visit.

The insurance company paid for the office visit, the 90714 and ibuprofen but is denying the 96372; saying the service represents an include component of the anesthesia package. Service denied.

I have looked in the CPT book and 96372 has nothing to do with a anesthesia package. I have always used 96372 in conjunction with 90714 but do not understand the denial. I have appealed twice and been sent back denied with no additional reimbursement.

Am I doing something wrong?

Thanks

Dave

Medical Billing and Coding Forum