Understanding when and how to apply the CPT code 96372 can help optimize your billing procedure. Accurate medical coding is the cornerstone of the physician’s work when paying for services rendered to patients. As an alternative, it’s critical to make sure you receive payment for your services promptly. Providing services has a corresponding billing code, and providers must always apply these codes correctly to receive reimbursements from insurance payers.
What does CPT CODE 96372 Mean?
Any diagnostic, therapeutic, or preventive substance (a medication, a fluid, etc.) administered by a doctor or assistant falls under the 96372 CPT code. This has accomplished by administering an injection into the patient’s body either intravenously (96373), subcutaneously (96372), or intramuscularly (96372).
It can also be injected into an intravenous catheter or intravascular access device for infusion (96374 CPT code is used for billing a single or initial substance). For follow-up sub-sequential IV pushes after 30 minutes, patients may bill under CPT 96375 or 96374.
A push procedure is an infusion that lasts less than 15 minutes. The injection of a drug, toxoid, vaccine, or vaccine/toxoid in a vial is not covered by the 96372 CPT code and should instead be individually charged using the proper Level II CPT and HCPCS codes.
Brief Description of CPT Code 96372
The following is a description of the CPT code 96372.
When a medical practitioner or other healthcare provider administers a therapeutic, diagnostic, or preventative drug to a patient through subcutaneous or intramuscular injection, CPT 96372 will be charged. Although it includes direct physician supervision, it is unnecessary when billing the hospital. Injections performed without a doctor’s supervision will record CPT 99211 rather than 96372CPT. It does not include the delivery of vaccines or poisons and must be billed separately.
Billing Instructions for CPT 96372
The list of acceptable modifiers to attach to CPT 96372 is as follows:
- 89, AI, CC, CR, ET, EY, GA, GC, GJ, GK, GR, GU, GY, KX, GZ, Q5, Q6, QJ, XE, XP, XS, XU, 51, 52, 58, 59, 76, 77, 78, 79, and 89
- Modifiers 59, 76, and 77 are most typically used when 96372 CPT is used.
- If the Evaluation and Management CPT codes (99201-99499) are not connected to injection, Modifier 25 will be added (96372 CPT code).
CPT Code 96372, Including Modifier 59
The unique services or processes not often billed together on the same day are typically appended with modifier 59. Instead of using modifier 59, we may use 76 or 77 when the same or a different physician, respectively, performs a service or therapy on the same anatomical site. Services documentation must include the usage of Modifier 59. These are the following reasons when modifier 59 needs to append with CPT 96372:
Each subsequent intramuscular or subcutaneous injection provided to the patient after another on the same day must include the modifier 59. It has carried out directly under the supervision of a physician for every subsequent injection.
A 49-year-old man who was experiencing shoulder pain came into the office. The examination revealed that he had a respiratory illness. For a respiratory infection, the doctor administered an injection of vancomycin. In this instance, we will add modifier 25 to the Evaluation and management code (99201-99499) for shoulder pain. A physician-injected substance or medication will also have modifier 59 associated with CPT 96372. As a result, it would look like this:
- (J06.9) ICD 96372 – 59 (J06.9)
- ICD J3370 (M25.519) ICD 99214 – 25
Reimbursement
According to the National Correct Coding Initiative (NCCI), the 96372 CPT code is reimbursable whether billed separately or in combination with other services by adding the proper modifier as necessary.
CPT 96372 is not reimbursable separately if the same renderer provides it on the same day as evaluation and management services (CPT Codes 99202-99499). However, if any unrelated, significantly recognizable evaluation and management services are offered along with therapeutic injection, 96372 CPT is reimbursable. On the CMS-1500 Box 19 or the equivalent loop and section of the 837P, record the name and dosage of any drugs the doctor has recommended.
Examples
Here are four medical scenarios when using CPT code 96372 is appropriate.
Scenario .1
A female patient with a PMH gastric sleeve, age 35, complained of dysuria, itching in her vagina, and white discharge over the previous two to three days. The patient reports only having one sexual partner, no other arm or leg pain, SOB, chills, headache, changes in vision, chest pain, palpitations, n/v/d/c, hematuria, or other symptoms of illness. She says she’s previously had symptoms like these. The UA revealed 1+leuk esterase and 300+ bacteria, so the doctor chose to provide 150mg of Diflucan.
Scenario .2
We encountered a patient with PMH cerebral palsy who is 49 years old. After bending forward, slipping, and hitting his head against the wooden cabinet, the patient complains of severe head pain. The patient denies any prodromal or loc symptoms. He doesn’t use any blood thinners, either. He denies experiencing weakness, numbness, or changes in eyesight. Furthermore, the patient denies having f/c, cp, sob, n/v, stomach discomfort, dysuria, and hematuria. A head CT and MRI detected migraines. A doctor chose to provide a 140mg injection of sumatriptan to treat migraines.
Scenario.3 (CPT Code 96372)
A 33M PMH IDDM and HTN patient with hyperglycemia and symptoms of nausea and vomiting presents. The patient reports that he started experiencing broad weakness and pain throughout his body 1.5 weeks ago. He started experiencing nausea and vomiting two days ago after eating lunch and hasn’t been able to swallow anything since.
Additionally, he mentions breathlessness that becomes worse with activity and dizziness with walking. His blood glucose was 600 when he arrived in the ED. He denies having a fever, chills, chest pain, dysuria, diarrhea, constipation, stomach pain, numbness, or encounters with sick people recently. He has not had a covid vaccination. laboratory reviews Cr 5.6 (an increase from 2.9 last year). pH 7.335, WBC 16.5, and AG of 17. Due to poor kidney function and bicarb retention, the patient is not acidotic. Supplementation of fluids will be KCl 3 runs and potassium 4.3. The patient will also begin receiving insulin by drip. 1U/kg/hr. Pt with the elevated white count left shift and elevated lactic will broadly cover with Vancomycin 500mg. Upon increasing his blood pressure to 203/114, he received home medicine containing Hydralazine 100 and Amlodipine 90.
How NEO MD works?
Since the tasks involved in medical billing and coding can be somewhat tricky. Therefore, it might not be a good idea to handle these procedures internally from an economic or strategic perspective. Maintaining compliance with the rules and regulations that are constantly changing is another difficult task for medical offices. Coding for CPT CODE 96372 and other codes is strange because the industry is changing quickly.
Top US revenue cycle management companies handle a large number of emerging medical billing operations. Few medical billing companies have services that healthcare practitioners are likely unaware of.
All practices can benefit from our services, no matter how big or small. Our services help lower overhead expenses brought on by incorrect billing. When required, we update data, address weaknesses in procedures, and quickly verify and fix issues. We closely monitor regulations that might increase operational productivity and cash flow. Additionally, we continually update our revenue cycle management services to make sure they comply with CMS regulations.
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NEO MD stood best among competitors due to the following core;
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