I have been getting a lot of email questions about whether or not 96372 can be used for inpatient billing. Here is the exact text of the description of 96372 from the CPT book:
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
The description itself does not specify a location, so I have billed it for many different settings, and I have never had a problem. Here are the notes included with the description
Do not report 96372 for injections given without direct physician or other qualified health care professional supervision. To report, use 99211. Hospitals may report 96372 when the physician or other qualified health care professional is not present.
Your front desk staff are the marines of your office. The doctor is the general, the office manager and billers are the lieutenant and sergeants, and you can’t run a successful campaign without them. But your front desk staff are the boots on the ground, first in, last out. Their actions represent the first impression patients get of your office, and they have the last interaction with patients before those patients leave. I know that mostly, by the time you come to this blog for help, the patient has already been seen and you need to know how to get the charge paid.
But I get your emails, I know what you really need.
In a perfect world, insurances would just pay what they were supposed to, patients would send in their checks on time, and we could all leave work at 5:00. This post will help you get a little closer to that perfect world, and it all begins with your front desk. Many offices, family practice and specialists alike, end up seeing patients with insurance that is not on file, termed, or non-contracted. This happens for a variety of reasons. New patient’s tell us they have PPOs when they really come in with HMOs. Established patients forget to tell us that they changed insurance 2 months ago. HMO patients forget that if they change their PCP, they can’t come to us anymore. Howeever, with the proper procedures, the number of patients with these issues that actually get in to see the doctor can be virtually eliminated. I recently had someone contact me to train their front desk, and this is the checklist that we put together to ensure that the doctor will be paid for every service he performs.
When a patient calls in to schedule an appointment…
New patients – Many offices send patients to complete their paperwork online. If you do this in your office, you only need to get the name and phone number when the patient is on the phone.
Name and phone number
Insurance name and id#
Date of birth
We have your phone number as (909) 555-5555, is that still correct?
And we have you with BlueCross BlueShield, is that correct?
The day before the appointment….
Call to confirm appointment
If your patient filled out their paperwork online, verify eligibility
If patient has not been seen within 30 days, verify insurance (eligibility, deductible, copay)
Call to confirm appointment
Also, please be aware you have a balance of $XX.00. See you on Friday!
When the patient checks in…
We still have your address as 1122 N. Del Sol Lane, is that correct?
Collect any copay/deductible. If you are collecting toward a deductible, charge $50 and tell the patients this will be applied toward their deductible. Anything over that the insurance applies will be billed to their account. Unless the patient is in for a post-op, blood draw, or follow up for an established condition. In that case, the service the doctor performs probably won’t end up with an allowed amount of more than $50.00. We want to be very careful that we don’t charge patient’s more than the insurance allowed amount when we collect toward their deductible.
Copy any new insurance cards
When the patient leaves the office…
Schedule any necessary follow up appointment.
Collect for any additional procedures performed (cash patients)
Put in for any referrals
I have included this Front desk checklist on the links and tools page for you to download. These procedures are small changes that can have a transformative effect on your office and allow your billers to concentrate on what you pay them for. Namely, fighting with the insurance companies. When your billers have to run around after the front desk and try to solve these issues after the fact, it’s too late. As always, call or email with any questions. I love hearing from you.
Medicare routinely pays for two immunizations and will pay for two others under specific circumstances. Specifically, they will pay for influenzaand pneumococcal as preventive, and Medicare will pay for the tetanusand hepatitis B vaccines in certain cases with medical necessity. Read on.
The new Medicare flu codes have been around for a while, but we recently ran into a few offices in 2012 who told us they have been having a hard time getting paid for their flu shots from Medicare. Long story short, they were using the wrong substance AND administration codes. And since Medicare will pay just under $30 for the administration of the injection and $7-$15 for the substance itself, missing out on those can turn into a loss of hundreds of dollars per year. So, lets fix that, shall we?
All of our posts are going to follow the same format; we are going to first explain the important bits, and then we give you the charts and links that we personally use and distribute to our customers. So remember to bookmark us or add us to your favorites, because here you can keep all of your invaluable tools in one place.
The CPT codes for Medicare to bill the flu shot break down by the brand the doctor purchases. If you’re at the office, take a look in the fridge, but if you are at a billing service, you need to please call your office manager and get that information. The reimbursement varies significantly depending on the code, and we can get our providers audited if we just make that decision ourselves. Medicare uses codes Q2034–Q2038, and here is the specific breakdown.
Remember to bill the G0008 administration code along with the vaccine. The Q-code is only for the substance. It is the G-code that we bill for the actual service–the process of injecting the immunization into a patient’s–ahem–hip. If the patient is ONLY seen for the flu shot, then you would simply bill those two codes. If the patient had an exam on the same visit you can bill an E&M code as well and Medicare will pay them all separately without any modifiers necessary. Just remember to put your V04.81 (ICD10 Z23) diagnosis primary on the Q-code and the G-code and your medical diagnosis on the E&M. Please remember, these codes are just for Medicare. For the rest of your private insurances, you still use the 90658 for the substance and the 90471 or 90472 for the admin.
The pneumo, Hep B, and the tetanus are a little bit easier.
For the pneumococcal, you bill with the diagnosis of V03.82 (ICD10 Z23) and the CPT code 90732. Use G0009 for the administration. Easy.
Medicare will pay for the tetanus immunization, however, they will not pay it as a preventive service. Patients who come in with wounds (ICD9 codes 860.xx0-894.xx and ICD10 codes S00-T14) are eligible for reimbursement on the tetanus vaccine. Remember to use the wound diagnosis primary and the V03.7 (ICD10 Z23), tetanus toxoid alone, as secondary. The tetanus can be billed with 90471 as the administration.
For hep B, Medicare will only pay for the immunization series for patients they consider as “high risk.” A high risk patient is one with renal disease, or hemophilia, or a client of institutions for the mentally handicapped.
A word of caution: Medicare has VERY strict rules regarding the frequency of these immunizations. The flu and the pneumo vaccines can be administered once per year. If 365 days have not passed since the last immunization you WILL NOT be paid.No amount of appealing will change this. Please, make it clear with your front desk, your MA’s, and most importantly, with your doctors, that we need to check the date of the last immunization for our established patients BEFORE administering the vaccine.
Here are your tools:
For starters, we reference this handy-dandy chart for all of our customers that breaks down the Medicare flu shot codes. Print it out, stick it on your wall. That’s what I did.
This is a link directly to the CMS Medicare site with all the information you could ever want regarding their immunization policies.
If this doesn’t answer all of your questions, call us at (909) 374-5439 and ask for Heather. Or you can email us at firstname.lastname@example.org.