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Can we charge for the administration of the Insulin?

Terri Posted Mon 02nd of April, 2012 20:03:42 PM

J1815 - we have samples that we give to the patient

SuperCoder Answered Mon 02nd of April, 2012 20:38:38 PM

Insulin as a therapeutic injection to control the patient’s diabetes,you should link the injection (96372, Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) to the diagnosis for diabetes, such as 250.03 (Diabetes mellitus without mention of complication; type I [insulin dependent type] [IDDM] [juvenile type], uncontrolled).

Of course, the doctor would have to evaluate a patient who presents with elevated blood sugar to determine necessary treatment. Therefore, the FP should also report the appropriate-level office visit (99211-99215, Office or other outpatient visit for an established patient), which he or she should link to 790.6 (Nonspecific findings on examination of blood; other abnormal blood chemistry). Some carriers, such as Medicare, do not pay the injection administration code (96372) when submitted with an E/M code (9921x). But most commercial insurers will pay for both the procedures and the service without a modifier. Thus, unless you know that the payer disallows the administration charge, you should file it.

In addition to reporting the payer-preferred injection and E/M combination, don’t forget to code for the insulin medication. For carriers that accept HCPCS level-two supply codes, you should report J1815 (Injection, insulin, per 5 units) per five units of insulin used. Otherwise, use CPT supply code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials

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