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  1. Jan Howard Posted 13 day(s) ago

    If a patient comes in for a sore throat and is tested and diagnosed with strep and is given a shot of rocephin, would we bill the E/M with modifier 25, 96372 and the J code for the injection? I have been given conflicting answers by two different consultants. One says not to bill the 96372 unless it is not directly related to the E/M. The other says to bill the 96372 and fight with the insurance company for payment if they don't pay it.

  2. SuperCoder Posted 12 day(s) ago

    When you have performed the procedure except the E/M then you can bill that procedure without fear of denial. The insurance will surely pay if the procedure is medical necessity of the patient. So bill E/M and CPT 96372 and J code for supply. Now the thing is, should we append modifier with E/M or not? When you perform the procedure and that is significant, separately identifiable E/M service then you can append modifier 25 with E/M code. In your case, as per CCI edits rules, CPT 96372 is showing that office visit code is a column 2 code for 96372, modifier 25 is allowed in order to differentiate between the services provided. So, use modifier 25 with E/M code.

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  • Posted by 30530 Jan Howard, 13 day(s) ago. There are 2 posts. The latest reply is from SuperCoder.