CPT Code 96372 is a medical billing code used by healthcare providers to bill for the administration of certain types of intravenous or injection medications. Medical billing professionals use the Current Procedural Terminology (CPT) code set to describe medical procedures and services accurately and consistently.
Applications of CPT Code 96372
CPT Code 96372 is primarily used to bill for the administration of drugs or therapies that are given intravenously or by injection. This includes medications such as antibiotics, chemotherapy drugs, and other types of injectable treatments. Injections into the subcutaneous, intramuscular, and intradermal tissues are also possible with it.
Both inpatient and outpatient settings, such as hospital stays, doctor’s offices, and clinics, are accepting applications for the code. Home health care is another prominent use, especially for injectable therapies given to patients in the comfort of their own homes.
Benefits of CPT Code 96372
CPT Code 96372 provides many benefits for healthcare providers and patients.
For healthcare providers, using CPT 96372 helps ensure that they are accurately and consistently billing for the administration of intravenous or injection medications. This helps to minimize the risk of denied claims, reduces administrative burden, and streamlines the billing process.
By using CPT Code 96372, patients may make sure that their bills for the services they get are accurate. This can help prevent misunderstandings or disputes over the cost of their care, and may also help reduce the overall cost of their medical care.
In addition, the use of the 96372 CPT Code also helps to promote transparency in the healthcare system by providing a clear and standardized description of the procedures and services provided. This can help build trust and confidence in the healthcare system and encourage patients to seek the care they need.
Understanding CPT Code 96372
The American Medical Association’s Current Procedural Terminology (CPT) code 96372 is a medical procedural code that falls under the category of Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes chemotherapy and other highly complex drug or highly complex biologic agent administration); subcutaneous or intramuscular.
96372 CPT code reimbursement is permitted whether the injection is performed alone or in combination with other procedures/services as permitted under the National Correct Coding Initiative (NCCI) procedure to procedure editing. Separate reimbursement will not be authorized for 96372 CPT when billed in combination with an Evaluation and Management (E/M) Service (CPT codes 99201-99499) by the same rendering provider on the same day of service. The CMS-1500 Box 19 or the corresponding loop and segment of the 837P must provide the drug name and dose if the patient is providing their own medication.
Reasons for CPT code 96372 denials:
Here are the justifications given by the American Medical Association (AMA), Current Procedural Terminology (CPT), and Centers for Medicare and Medicaid Services (CMS) for rejecting CPT code 96372.
- In an institutional environment, the physician reports CPT code 96372.
- CPT 96372 code is filed on the same day as an E/M service and CMS Place of Service (codes) 19, 21, 22, 23, 24, 26, 51, 52, and 61 for the same patient by the same individual physician or another qualified healthcare professional. Regardless of whether a modifier is recorded with the injection, just the E/M service will be paid (s).
- Another healthcare provider, other than the physician or other trained health professionals, performs procedural code 96372 in a non-facility environment without direct supervision for patient evaluation, consent giving, safety monitoring, and intra-service supervision of staff. CPT code 99211 would be acceptable to report this type of situation.
- The procedure code 96372 already contains a general examination of the patient.
- If the necessity for the injection was previously determined at the prior visit (billed as an E/M code), you cannot bill for the same treatment twice. However, if an extra E/M service was delivered in addition to the injection, you can bill for both the injection and the E/M code at the same visit. That E/M service would have to be properly recorded.
- Incorrect or absent modifier.
- CPT code 96372 is not correctly documented, demonstrating that a treatment or service was separate or independent from other services done on the same day.
- CPT number 96372 assigned to various types of vaccines. Most of the immunizations usually tagged with 90471 or 90472. The administrative code for flu shots in Medicare is G0008.
- Injections connected to the administration of chemotherapy treatments are invoiced under procedure code 96372. The appropriate CPT code is 96401-96402.
CPT Code 96372 is an important tool for healthcare providers, billing professionals, and patients. By providing a standardized and accurate description of the administration of intravenous or injection medications, CPT 96372 helps to ensure that medical services are accurately billed, reduces administrative burden, and promotes transparency in the healthcare system. Whether you’re a provider or a patient, understanding CPT 96372 and its applications and benefits is key to ensuring that you receive the care you need, at a cost that you can afford.
Understanding Modifier 59
Modifier 59 use to distinguish procedures or services that have not usually performed together but are justifiable in specific circumstances. The documentation must show that the procedures perform in separate sessions, at different sites, or on different organs, or involved separate incisions, lesions, or injuries. If another established modifier is available, it should be used instead of Modifier 59. Modifier 59 has considered a last resort option, only to use when no other modifier is appropriate and its use best explains the situation. It should not use with evaluation and management services.
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