You may streamline your billing process by understanding when and how to utilize the CPT code 96372. Correct Medical Coding is the essence of Physician’s services provided to the patients when billing. Alternatively, ensuring that you are being paid on time for services rendered is vital. Every service has an associated billing code, which needs accurate applicability every time if providers are to get more timely and complete payments from insurance payers. The truth is that insurance companies will look for any excuse to deny your claim, and billing code errors are a significant factor in this.
What is CPT Code 96372?
The 96372 CPT code is a procedural code that indicates the administration of a therapeutic, prophylactic, or diagnostic drug by subcutaneous or intramuscular injections and infusions.
Any diagnostic, therapeutic, or preventive substance (a drug, a fluid, etc.) administered by a doctor or assistant falls under the CPT code 96372. This is performed out by an intra-arterial injection (96373), subcutaneous injection (96372), or intra-muscular injection (96372) into the patient’s body.
96372 CPT Code Description
The 96372 CPT code description is as follows.
When a medical practitioner or other healthcare provider administers a therapeutic, diagnostic, or prophylactic drug to a patient through subcutaneous or intramuscular injection, CPT 96372 will be billed. Although it includes direct physician supervision, it is not necessary when the hospital is billing. When a drug has been injected without a physician’s supervision, CPT 99211 will be reported rather than 96372 CPT. It excludes administration of Vaccines or toxoids and is separately billable.
Related 96372 CPT Codes
A patient’s billing should include the CPT code 96372 for every injection they receive. If the injection is a separate service from other treatments, usage of modifier 59 shall include mandatory.
The following CPT codes associated with this code include:
96373: Prophylactic, therapeutic, and diagnostic substance by intra-arterial injections and infusions.
96374: Therapeutic, prophylactic, and diagnostic substance by IV-push injection of a single or initial substance or drug.
96375: Therapeutic, prophylactic, and diagnostic substance by IV-push injection of an additional or subsequent substance or drug.
96376: Therapeutic, prophylactic, and diagnostic substance injection of an additional or subsequent substance or drug using an on-body injector.
96377: Application of on-body injector (including cannula insertion) for subcutaneous injection.
96379: Unlisted Therapeutic, prophylactic, and diagnostic intravenous or intra-arterial injection or infusions.
Reimbursement Guidelines for CPT Code 96372
Healthcare offices and facilities around the country are experiencing coding difficulties with CPT® 96372. And Providers are not receiving payment for the administration of subcutaneous or intramuscular injection of a specific substance or drug for therapeutic, preventative, or diagnostic purposes as they incorrectly applied codes.
According to the National Correct Coding Initiative (NCCI), the CPT Code 96372 is reimbursable whether billed separately or in combination with other services by adding the proper modifier as necessary.
CPT 96372 is not reimbursable separately if the same renderer provides it on the same day as evaluation and management services (CPT Codes 99202-99499). However, 96372 CPT is reimbursable if any unrelated, significantly identifiable assessment and management services are provided with therapeutic injection. Indicate the dosage and name of any drugs the doctor prescribes on the CMS-1500 Box 19 or the 837P’s comparable loop and section.
Leading Causes of CPT Code 96372 Denials
Here are the explanations specified by the American Medical Association (AMA), Current Procedural Terminology (CPT), and Centers for Medicare and Medicaid Services (CMS) for why CPT code 96372 gets rejected.
- The physician reports CPT code 96372 in a facility setting.
- The same physician or other qualified healthcare providers on the same day of service submits 96372 CPT code along with an E/M service and CMS Place of Service (codes) 19, 21, 22, 23, 24, 26, 51, 52, and 61 for the same patient. Regardless of whether a modifier has been reported with injection, only the E/M services will reimburse.
- In a non-facility context, procedural code 96372 performs by a healthcare provider other than the doctor or other certified healthcare professionals without direct supervision for any or all patient evaluation, consent-giving, safety monitoring, and intra-service staff supervision needs. While reporting this kind of situation, use priorly CPT code 99211.
- The CPT code 96372 already includes a general assessment of the patient.
- You cannot bill for the same treatment again if the need for the injection Was determined at the last visit (billed as an E/M code). If an extra E/M service has delivered in addition to the injection, you could bill for both the injection and the E/M code at the same visit. That E/M service would need to have the correct paperwork.
- Incorrect or absent modifier.
- CPT code 96372, which denotes that a treatment or service was distinct from others offered on the same day, might report incorrectly.
- Certain vaccinations cover under CPT code 96372. Usually, the codes for vaccinations are 90471 or 90472. The administrative code for flu vaccinations in Medicare is G0008.
- Injections connected to the provision of chemotherapy treatments may bill under procedure code 96372. The proper CPT code to use is 96401-96402.
CPT Code 96372 With Modifier 59
The services or processes that are unique and not often billed together on the same day are typically appended with modifier 59. Instead of using modifier 59, we may use 76 or 77 when the same or a different physician, respectively, performs a service or therapy on the same anatomical site. Services documentation must include the usage of Modifier 59. These are the following reasons when modifier 59 needs to append with CPT 96372:
Each subsequent intramuscular or subcutaneous injection provided to the patient after another on the same day must include the modifier 59. It has carried out directly under the supervision of a physician for every subsequent injection.
Example: A 49-year-old man came into the clinic complaining of shoulder pain. During the checkup, physicians diagnosed him with a respiratory infection. For a respiratory infection, the doctor injected Vancomycin. In this case, the Evaluation and management code (99201-99499) for shoulder pain will have modifier 25. Additionally, modifier 59 will also include with CPT 96372 for any substance or drug a doctor injects. Therefore, it would be like this:
- (M25.519) ICD 99214 – 25
- (J06.9) ICD 96372 – 59
- (J06.9) ICD J3370
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