CPT Code 96372 Description and Reimbursement Guideline

Consider the following scenario: You charge for a specific CPT injection code, but you are denied or rejected. That is a relatively regular event. Wouldn’t you be disappointed, especially if you didn’t know why you were turned down?

When invoicing for specific operations, the medical provider or coder must be experienced enough to know which CPT codes to report. Furthermore, a modifier should be indicated for the procedure code in specific cases, and it should be compatible with the CPT code. Incorrect or missing modifiers might result in the insurance issuing Denial Code CO4; this is one of the most prevalent grounds for medical billing denials. You can also read about benefits of outsourcing medical billing services.

So, what are you going to do? The next step would be to resubmit the claim line with the correct qualifier for processing, but it is not essential to go through the reopening procedure.

CPT Code 96372 Description

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.

CPT Code 96372 Reimbursement Criteria

When the injection is done alone or combined with other processes permitted by the National Correct Coding Initiative (NCCI) process to process modification, CPT code reimbursement is authorized.

When invoiced in combination with an Evaluation and Management (E/M) Service (CPT codes 99201-99499) by the same rendering source on the same day of operation, additional reimbursement for CPT code 96372 will not be permitted. If a physician’s medicine is provided, must note the drug name and dose on the CMS-1500 Box 19 or the comparable loop and section of the 837P.

Reasons of Denials for CPT code 96372

According to our survey with accounts receivable services team, the following are the reasons why CPT code 96372 is rejected under American Medical Association (AMA) Current Procedural Terminology (CPT) and Centers for Medicare and Medicaid Services (CMS) rules.

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. Read a detailed guide about professional vs institutional claims.

A comprehensive evaluation of the client is already included in procedure code 96372.
You could not bill for the same treatment if the necessity for the injection were previously determined during the prior appointment (billed as an E/M code).
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.
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.
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.

Use of Modifier 59 with CPT 96372

Modifier 59 is used to designate processes or operations other than E/M services and are not typically reported simultaneously but are acceptable in the conditions. Documentation must demonstrate a particular session, procedure, surgery, organ system, cut or removal, separate lesion, or separate damage that is not typically seen or done the same day by the same practitioner.

When some other previously existing modification is more suitable, it should be used instead of modifier 59. Modifier 59 should be used only if no other explanatory modifiers are provided, and the usage of modifier 59 best explains the situation. As a result, CPT modifier 59 is frequently used as a “last option modifier.” Furthermore, modifier 59 must not add to an E/M application.

Incorrect Use of Modifier 59

Modifier 59 is utilized when it is not medically required.
Modifier 59 denotes that executed a method code more than once each day. Instead, utilize anatomical variables to differentiate their recurrent operations.
If those options were not accessible, apply modifier 76 (repeat service), as advised by MAC.
Modifier 59 added to packaged operations done via the same incision – specific codes cannot be separated even with modifier 59.

When should you use CPT 96372 prefixed with 59?

CPT code 96372 must be documented for each injection administered when a patient is receiving two or three intramuscular or subcutaneous injection. CPT code 96372 must be documented for each injection administered when a patient is receiving two or three in

To put it another way, attaching CPT modifier 59 implies that the injection is a distinct operation. CPT code 96372 needs direct medical supervision for professional documentation. It is recorded each infusion, even if the input contains more than one chemical or medication. The usage of this modification must be supported by documentation in the patient’s medical record.

Frequently Asked Questions about CPT 96372

What is the CPT code for injection administration?

The CPT code 96372 should be used to bill Therapeutic, prophylactic, or diagnostic injection.

What is the CPT code for subcutaneous injection?

The CPT code 96372 should be used to bill Subcutaneous or intramuscular forms injection.

Final Thoughts about CPT 96372

Billing and coding activities can be time-consuming, and it may not be cost-effective or strategic to conduct these processes throughout. Furthermore, the sector is evolving at an extraordinary speed, making it challenging for medical practices to maintain pace with the constantly changing laws and regulations in medical billing and coding.

Outsourcing your medical billing and coding is among the most effective methods to improve the efficiency of your payment process and boost the patient experience. Right Medical Billing delivers medical billing and coding services and ensures correct and on-time payment.

We realize how important it is to input accurate info to avoid delays or rejections on the insurance provider. Our staff has been trained to conduct medical and coding tasks such as patient data, CPT, ICD code with modifiers, etc. If your practice needs medical billing help, don’t hesitate to contact us to schedule an appointment with one of our billing specialists.