If your medical specialty involves diagnostic injection, then you must be familiar with CPT code 96372. If you do not, there are high chances of frequent claim denials and rejections.
CPT code 96372 is completely specific, yet it is used under various medical specialties. Whether it is internal medicine, pediatrics, emergency medicine, or family medicine, knowing this CPT code helps you reach your revenue goals.
However, utilizing CPT code 96372 accurately requires comprehensive coding skills and knowledge. Even the usage of modifiers must be compatible with this CPT code. Inaccuracies can cause denials and disrupt the flow of administrative operations.
That is why understanding the 96372 code is essential to preventing revenue leakages. This blog brings attention to this complex code and gives healthcare providers a clear insight into its purpose and usage. Let’s learn!
What is CPT Code 96372?
The CPT code 96372 description gives a clear idea of where and how it must be utilized. Under the American Medical Association (AMA), this code is used for therapeutic, prophylactic, or diagnostic injections (specify substance or drug), subcutaneous or intramuscular.
The CPT code 96372 definition highlights medical billing of a drug given by injection to a patient. This code only includes drug injections into the subcutaneous tissue or muscle and excludes intravenous injections (such as in chemotherapy).
This distinction for usage of injections is the reason behind the complexity of code 96372. Even minor errors in understanding this code can lead to denials.
Key Parameters of CPT Code 96372 for Adequate Revenue
For accurate utilization of CPT code 96372, healthcare providers must take care of certain factors. For accurate utilization of CPT code 96372, healthcare providers must take care of certain factors. They must meet criteria to ensure proper claim filing.
Whether a drug is injected in a single procedure or combined with other procedures, 96372 is applied. However, the procedures must be allowed under the National Correct Coding Initiative (NCCI).
Here are some other important parameters healthcare providers must accomplish:
- If an injection procedure is done along with an evaluation and management (E/M) service, the healthcare provider cannot receive revenue for both.
- To reimburse under CPT code 96372, healthcare providers must present records that specify the name of the drug and its required dose.
- Whenever a healthcare provider is billing for an injection procedure, the process must adhere to CMS-1500 guidelines.
- In certain cases, 96372 is written with relevant modifiers. Not mentioning modifiers results in denials and rejections.
Common Factors Leading to Denials for CPT Code 96372
Now that we know the key parameters of reimbursement through 96372 codes, let’s discover some of the common reasons behind denials.
The American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) outline certain guidelines for CPT code 96372. If any healthcare practice fails to meet these guidelines, it faces claim denials.
The reasons are as follows:
- If CPT code 96372 is reported by a hospital or any other healthcare institution.
- If a healthcare provider renders therapeutic or diagnostic injections without any medical supervision in a place other than a hospital or healthcare facility. There are other CPT codes specifically designated for this.
- If a healthcare provider bills a patient for a comprehensive evaluation separately from the therapeutic or diagnostic injection.
- The guidelines do not allow billing a CPT code 96372 if it has already been billed under the Evaluation and Management (E/M) service during a previous visit.
- The guidelines prevent billing for a single medical service twice under the code 96372 at once. But if the healthcare provider provides Evaluation and Management (E/M) service together with injection procedure, billing both is allowed provided that E/M service is properly documented.
- If the CPT code 96372 is inaccurately documented with no clear distinction between injection procedures and other treatments.
- Even though code 96372 is meant for injection procedures, it is not the code for various vaccines. There are different specific codes for vaccines, such as 90471 or 90472. Under Medicare, flu vaccines have a particular code: G0008.
- This CPT code may be used along with chemotherapy, but it is meant to bill chemotherapy. There are separate codes for infusion or injection of chemotherapy drugs.
Modifier 59 with CPT Code 96372
There are chances that a patient receives multiple injections in a single visit. No matter the number of injections, all of them have to be reported separately. The question here is, how is it possible with a single CPT code? That is why Modifier 59 comes into the picture.
The modifier is meant to distinguish one CPT code for injection from another. So, whenever a healthcare provider is using CPT code 96372 for more than one injection, there is a need for modifier 59 to specify Distinct Procedural Service.
This distinction is essential to prove the uniqueness of a procedure and avoid inaccurate recording or duplicate services. The usage of modifiers is crucial to improving revenue cycle management.
Billing Issues Due to Incorrect Usage of Modifier 59
Appropriate usage of Modifier 59 is a significant part of ensuring a high-performance medical billing process. On the contrary, improper usage can lead to issues disrupting the operational and revenue flow.
Here are some important factors of billing with Modifier 59:
- Healthcare providers can use Modifier 59 only when it is strictly required and not otherwise. There must be a valid medical reason to allow multiple procedures.
- As Modifier 59 is meant to distinguish two injections given during a single appointment, healthcare providers need to justify the necessity of all injections provided.
- While mentioning Modifier 59, it is advisable to also clarify the anatomical sites of the procedures. Using anatomical modifiers gives a clear justification.
- If a procedure is repeated on the same anatomical site, then using Modifier 76 is more suitable than using Modifier 59. This modifier also helps in defining the same procedure performed again.
- Healthcare providers cannot use Modifier 59 to separate bundled services. This is not accepted by insurance companies.
Bottom Line
CPT code 96372 is meant for a specific procedure and requires precision. Healthcare providers need to maintain all fundamentals of this code to receive adequate revenue.
Coding is complex, and it requires comprehensive skill and knowledge. The same goes for the case of code 96372. It becomes the responsibility of healthcare providers to meet all requirements and ensure a higher clean claim rate.
To solve this issue, healthcare providers and practices have the option to outsource their medical billing services. Partnering with professionals not only helps with coding but also streamlines the entire medical billing process. It gives healthcare providers a chance to shift their administrative burden and focus on improving the quality of patient care.
To get expert medical billing services, you can select Eminence RCM!
Eminence RCM is a medical billing company proficient in handling coding for all types of medical specialties. We work with a certified team of coders who understand every nuance of CPT code 96372. Our team promises accurate translation into codes and timely claim filing and submission. We believe in delivering top-quality services so that you can achieve adequate reimbursement.
So, partner with medical billing services that are experts at reducing complexities and improving revenue flow!