Medical Billing Forum

Billing => Billing => Topic started by: Scott on March 28, 2016, 07:14:45 PM

Title: Injections
Post by: Scott on March 28, 2016, 07:14:45 PM
Hi All.  I just wanted to confirm that we're doing this right.  We just took over a practice who administers various injections (B12 and cortisone shots predominantly) to their patients.  The practice also purchases the injections (i.e., they own the medication).  What I'm not sure of is whether the practice can bill for both the administration and the drug itself.  When the practice administers the injection in the office, I believe we should bill for the administration under 96372 with modifier 25.  Because the practice owns the medication as well, shouldn't we also bill the medication on a separate line using J3490 and the drug's NDC code?  Does that sound right?  Thanks in advance.
Title: Re: Injections
Post by: kristin on March 28, 2016, 10:10:07 PM
No modifier 25 on injection codes, that modifier is ONLY for E/M codes. If you happen to bill an E/M for something unrelated to the B-12 injection, then you put the 25 on the E/M code.

Yes, if the practice has purchased the injectable, they would also bill the appropriate J code, with the appropriate amount of units, along with the NDC code on the injectable, as well as the administration code, if applicable.
Title: Re: Injections
Post by: Scott on April 01, 2016, 05:48:22 PM
Thanks Kristin.  Just so I understand, if the injection is administered on the same day as an E/M service, you would modify the E/M code with the 25 and, in addition, bill the drug itself on a separate line with the J code, units, NDC, and AWP?

If the injection does not accompany an E/M service, you would bill the drug itself using the J code, units, NDC, and appropriate AWP?  What modifier do you use if there's no E/M service?
Title: Re: Injections
Post by: Michele on April 06, 2016, 08:24:40 AM
You don't need a modifier on the injection or the drug.  If there is an E&M on the same day that is separate from the injection (the patient was seen by the doctor for services that meet the requirements of the E&M separate from the injection) then the 25 modifier goes on the E&M.  If the patient is being seen only for the injection there should be no E&M.