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Antibiotic code 96372

Ray Posted Thu 18th of October, 2012 22:09:12 PM

we billed a well child check-up and a sick visit on the same day. For the sick visit we billed a 99213, J0696 and the 96372 which is the therapeutic antibiotic administration. This commercial carrier did not pay us for the 96372 because they stated that it bundled to the well child check-up admin codes of 90460 and 90461. I have never heard of this but their supervisor stated that this came from the American Coding Society and that it has been in place as far back a 1 year? can someone please confirm this? we even billed the 25 modifier on the 99213 (sick visit) to show them it is a seperate visit on the same day as the well child check-up.

SuperCoder Answered Tue 23rd of October, 2012 23:12:01 PM

Hi Ray,

We are working on this. Will get back soon with the answer.


SuperCoder Answered Thu 25th of October, 2012 11:09:38 AM

Hi there! Although I am not familiar with the American Coding Society, I can tell you that for this encounter, the appropriate coding would be:
99213-25 (linked to separate diagnosis)
96372 (may require modifier 59 depending on your insurer)
Code 96372 is a column 2 code with the IA codes (90460/904610) based on CCI edits, but a modifier is allowed to separate the edit.

Torrey Kim, CPC, CGSC
Editor, Pediatric Coding Alert

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