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Testosterone Injection

William Ivan Posted Fri 30th of May, 2014 09:52:05 AM

Patient comes to office for the sole purpose of a Test Injection. Physician billed for a 99211 and the injection. Physical exam was done and benefits and risks were communicated to patient. The 99211 was denied. Did we properly bill for this procedure? Should we have only billed for the testosterone injection?

SuperCoder Answered Fri 30th of May, 2014 12:17:16 PM

If the urologist performs a separately identifiable service at the same time as the injection, such as an office visit, you can report that service separately using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

A separate E/M service can be billed in conjunction with an injection administration as long as the documentation supports the E/M service.When reviewing the service, you should be able to identify a 'stand alone' examination, medical decision making, and/or HPI (history of present illness) to support the E/M service.

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In your case :

96372 -- Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular -- Use for testosterone injections

You cannot ever bill 99211 (Office or other outpatient visit ...) with 96372 (Therapeutic, prophylactic or diagnostic injection ...). In fact, according to the Correct Coding Initiative (CCI), no modifier will separate the edit bundling these codes together, so there are no circumstances under which they can be reported together. You have two options:

Option 1: You bill 96372 for the injection as an incident-to service if a supervising physician is present in the office.
Option 2: You bill 99211 instead.
This rule would only apply when a nurse (RN or LPN) is giving the injection, not the family physician, nurse practitioner (NP), or physician assistant (PA). If a physician or other qualified health care professional is administering the injection himself or herself and reporting it under his or her provider number, you should report the injection with 96372.

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