Armando Posted Fri 12th of July, 2019 13:31:54 PM
Hello, we have a Podiatrist specialist we are billing for. We bill out code 99213 using modifier 25 along with cpt code 20550-(RT), 29540-(RT,59), J2001, J3301 and dx are M79.671, M72.2 and R60.0 will this combination paid? or can we bill CPT 96372 and J2001 with separate claim. Need your assistance.
SuperCoder Answered Mon 15th of July, 2019 04:35:59 AM
Thank you for your question.
As per the above presented documentation, please find the undermentioned response.
As per CCI Edits, a provider shall not report a casting/splinting/strapping CPT® code for the same site as an injection or aspiration. So, do not report CPT® code 29540; if performed on the same site of the injection procedure.
HCPCS code J2001 states- Injection, lidocaine HCl for intravenous infusion, 10 mg. The route of administration is intravenous, which is an injection, or instillation of liquid, through a needle into a vein. If the route of administration is not intravenous, do not report.
Caution: Many payers do not allow separate reimbursement for local aesthetic, as they consider it to be part of the injection procedure."
HCPCS code J3301- If provider has administered triamcinolone acetonide, then reporting J3301 is appropriate. Just check for amount of drug administered, to report appropriate units of J3301.
Can we bill CPT 96372 and J2001 with separate claim?
No, the billing combination of CPT® code 96372 and J2001 is incorrect. CPT® code 96372 is for therapeutic injection administered subcutaneously or intramuscularly, whereas, J2001 is for lidocaine HCl for intravenous infusion.
CPT® code 96372 is a column 2 code for 20550 and 29540, but you may use a CCI-associated modifier to override the edit under appropriate circumstances, such as, if the injection was performed at any other anatomic structure other than the injection(s) on single tendon sheath, or ligament, aponeurosis.
Note: Kindly correlate your detailed procedure notes as per the above response for appropriate code reporting.
Hope that helps!