Cathy Posted Wed 21st of September, 2016 19:41:02 PM
We give hormone replacement therapy like depotestadial J1060 and delestrogen (compounded) drugs. I have been billing 96372 with N95.9 without the drug because you cannot bill a compound drug. I am reimbursed by most insurance companies for billing for the injection, but I know that I cannot bill a compound drug because there is no NDC number. I have not had any problems being paid for 96372 without the drug but I wanted to make sure that what I am doing is correct. I feel that this an actual service that we provide to our patients. It is given by the nurse. Is the insurance company assuming that I am giving a drug with a NDC. They do not require that we list the drugs that we give. depotestadial, b12, or delestrogen 20 mg (compounds) are not billinable by medicare but I have been billing medicare for the action of giving the drug 96372. Am I correct in doing so.
SuperCoder Answered Thu 22nd of September, 2016 04:42:21 AM
Cathy Posted Thu 22nd of September, 2016 19:50:19 PM
I already know that you cannot bill B12 unless you have a Diagnosis of pernicious anemia, but where can I look for information about using 96372 for compound drugs?
SuperCoder Answered Fri 23rd of September, 2016 02:01:33 AM
There is no specific link that mentions about using 96372 for compound drugs. There is no NDC for compounded drugs, however if you are the compounding pharmacy, then you can bill each drug separately, each with its own NDC. Please let us know for any further clarity. Thank you.
Cathy Posted Fri 23rd of September, 2016 15:55:53 PM
I am not the pharmacy. We are the Dr. office. We order the compound drug from the pharmacy per patient and bill out for the injection. Our patients pay for the meds and we bill our the injection because we have a nurse that gives it, so my question is it ok to bill 96372 eventhough we are giving a compound drug. Medicare, medicard and most insurance are paying us, but since you cannot bill a compound drug that when I started thinking do we have to use drugs with an ndc code to use 96372
SuperCoder Answered Tue 27th of September, 2016 08:20:15 AM
Hi, usually, if a drug itself is not billable, then 96372 is also not billable in that case, however you may check your payer preference for billing the same for drugs without an ndc. Thank you.