Author Topic: Billing two different Injection types (95117 & 96372)  (Read 3139 times)

Mfm_Josh

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Billing two different Injection types (95117 & 96372)
« on: March 05, 2020, 07:21:16 PM »
So I am the coder/biller for a PCP office.  I am having some trouble finding the proper way to bill (and get paid) for multiple injection types.  I believe this is due to the insurance thinking they are for the same injection (despite differing diagnosis codes). We have a patient that gets his allergy(immunotherapy) shots at our office.  He is also on testosterone replacement therapy via depo testosterone injections. So sometimes he is due both for his allergy injection + the depo-testosterone injection.  I've tried billing it the following ways to no avail.  I'd appreciate any help.   Is it because of only 1 j code? even though the vial is given to us by the patient or allergist?
1st way
line 1 96372 with mod 25
line 2 95117
line 3 j1071 (drug code for the depo testosterone)

2nd way
line 1 95117 with mod 25
line 2 96372
line 3 j1071

and just to make sure I also tried adding -25 modifier to line 2 just to try but of course that didn't work as its not the right way to use mod -25
Edit:  In case it changes things, the insurance is Anthem/ bluecross blue shield.  I'd be happy to give more info if its needed for someone to help me.   I'm almost to the point of talking to the patient and not letting him get both the same day.
« Last Edit: March 06, 2020, 04:18:55 PM by Mfm_Josh »

kristin

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Re: Billing two different Injection types (95117 & 96372)
« Reply #1 on: March 06, 2020, 09:35:32 PM »
Well, the 25 modifier is definitely wrong, for any of the codes, because it can only be appended to an E/M code. So take that off the table entirely.

Generally speaking, if there is any type of injection, the appropriate J code also needs to be billed along with the administration of the injection. Is there a J code that should be going in with the 95117, or is it considered part of that code? I am not familiar with allergy injections, but I have billed for IM docs who do multiple injections for various things on one day, and have been paid for everything.

You could try appending a 59 modifier to one of the administration codes, based on CCI edits, to know which one should get the 59. That would distinguish one administration code from the other on the same day.

Mfm_Josh

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Re: Billing two different Injection types (95117 & 96372)
« Reply #2 on: March 27, 2020, 01:58:34 PM »
the reason I tried modifer 25 was I was under the impression that 96372 for whatever reason infered a slight e/m.   I'll try modifier 59.  Thanks for the reply.

Collachi

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Re: Billing two different Injection types (95117 & 96372)
« Reply #3 on: May 06, 2020, 12:09:44 AM »
A little bit late to the party here...

A while back, Anthem BC here in California stopped paying for two different injection types in one session.  I tell the doc, when he asks me if he can do two different injections, you can do trigger points (20552-20553), you can do a pain shot (96372), you can do any number of them you want to do.  Big Blue is only going to pay for one of them.

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