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CPT 96372

Tim Posted Wed 29th of December, 2010 22:32:12 PM

Has anyone else been told by payers that cpt 96372 is part of a global fee and not reimbursible?

SuperCoder Answered Thu 30th of December, 2010 20:40:45 PM

Check NCCI edits prior to claim submission; edits are updated quarterly. NCCI edits are available at www.cms.gov/NationalCorrectCodInitEd/.

CPT codes 96372 and 96374 are bundled with many other procedures, including electroconvulsive therapy, biofeedback, some CPT codes for dialysis management, esophageal studies, some ophthalmologic studies, some diagnostic pulmonary procedures including spirometry, and many cardiovascular procedures including electrophysiologic studies, cardiac stress tests, and echography and diagnostic cardiology studies. Note that this is not an inclusive list.

Many Evaluation & Management (E/M) procedures are bundled into (included in the reimbursement for) CPT codes 96372 and 96374.

For these combinations of services, CPT codes 96372 and 96374 are designated with indicator '1' in the NCCI edit list. If this is a separate, distinct service (e.g., performed during a separate patient encounter), submit CPT modifier 59 to indicate that the injection procedure is a separate service. Documentation in the patient’s medical record must support the use of this modifier.

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