If you’re a medical coder, you’ll undoubtedly encounter many situations throughout your career where you have to make use of the CPT code 96372. Despite this, unfortunately, coders across the country are finding it difficult to appropriately use CPT code 96372. As a result, thousands of medical claims are getting denied regularly and healthcare providers are not receiving the reimbursement they are owed for the service they provide.
This is why it is so important for a medical coder to know how to appropriately use CPT code 96372 to accurately bill for the services you provide to your patients.
Continue reading to learn how you can use accurately use CPT code 96372 to optimize your billing processes and minimize claim denial rates.
What is CPT Code 96372?
As per the American Medical Association, 96372 is a Current Procedural Terminology (CPT) used to code for a medical procedure under the range of therapeutic, diagnostic, and prophylactic injections and infusions. It essentially codes for the intramuscular or subcutaneous injection of a small volume of medication to a patient in a single shot, as opposed to intravenous administration which is given very slowly and requires a greater commitment of time from the healthcare provider.
Related 96372 CPT Codes
Subsequent codes closely related to CPT code 96372 include:
- CPT 96373 – Therapeutic, diagnostic, or prophylactic intra-arterial injection
- CPT 96374 – Therapeutic, diagnostic, or prophylactic injection via an intravenous push of a single or initial drug or substance
- CPT 96375 – Therapeutic, diagnostic, or prophylactic injection via an additional or subsequent intravenous administration of a new drug or substance
- CPT 96376 – Therapeutic, diagnostic, or prophylactic injection via an additional or subsequent intravenous administration of the same drug or substance
- CPT 96377 – Therapeutic, diagnostic, or prophylactic injection via the application of an on-body injector such as the insertion of a cannula.
CPT Code 96372 Reimbursement Guidelines
Reimbursement for CPT code 96372 is authorized in one of two conditions:
- When the injection or infusion is performed as a separate medical procedure; or
- When the injection or infusion is performed in combination with other medical processes permitted by the National Correct Coding Initiative (NCCI)
When billed in combination with an E/M service (CPT codes 99201-99499) by the same medical provider on the same day on which the E/M service was provided, separate reimbursement will not be provided for the therapeutic or diagnostic injection(s). Instead, the healthcare provider will only receive reimbursement for the Evaluation and Management service they provided on that date, regardless of whether a modifier was appended with the CPT code.
CPT 96372 Coding Rules
Here are some general rules to remember when billing for CPT code 96372:
- CPT code 96372 can only be billed in a facility setting when the procedure is performed under the direct supervision of a medical doctor.
- The code must be billed per each injection performed and not per each drug administered. This means that even if one injection contains more than one drug, it will still be billed only once.
- The treatment plan devised by the physician and the medical history of the patient must support the intramuscular or subcutaneous injection of the drug.
- Procedure code 96372 cannot be billed for the administration of chemotherapy drugs or other highly complex biological agents or drugs. CPT codes 96401 and 96402 are used to bill for the administration of these drugs.
- CPT code 96372 should not be billed for the administration of vaccines.
- Injections for allergen immunotherapy should not be documented by CPT code 96372. For allergen immunotherapy injections, CPT codes 95115 – 95117 should be used instead.
- If the need for injection was already predetermined at the time of the patient’s last visit and was billed as an E/M service, then CPT code 96372 cannot be billed at the time of the patient’s current visit.
When Should Modifier 59 Be Used?
As per the CPT manual, Modifier 59 is used to describe a certain service or procedure performed by a healthcare provider as distinct or separate from other procedures/services performed on the same patient on the same date. Essentially, modifier 59 documents procedures/services that generally aren’t documented in conjunction but are appropriate to do so only for some special cases.
However, this modifier should not be used on an E/M code and should only be used when no other modifier seems appropriate. This is why it is called the ‘last resort modifier’. Only if no other modifier is deemed fit for the situation is modifier 59 used.
As we’ve already established, if a patient is given more than one subcutaneous or intramuscular injection, then each injection should be invoiced with a separate CPT code. Modifier 59 will then be used along with the second and every other subsequent injection code billed on the claim form. This is to indicate that the second and every other injection that follows is a separate service from the first injection.
However, if the volume of a single intramuscular or subcutaneous dose needs to be split into two or more syringes, you can only bill for a single unit of code 96372. For example, if you administer two different drugs to a patient, but have to use three separate injections to administer them, you would only bill for CPT code 96372 twice along with their drug supply codes and a modifier 59 code on the second injection code like this:
CPT 96372 (Therapeutic, diagnostic, and/or prophylactic injection, specify drug or substance; intramuscular or subcutaneous)
CPT 96372-59 (Therapeutic, diagnostic, and/or prophylactic injection, specify drug or substance; intramuscular or subcutaneous – Distinct Procedural Service)
Modifier 25 must also be attached with an Evaluation and Management code if an injection is given to the patient, but the Evaluation and Management service is not linked with the service of administering an injection to the patient. For example, a patient presents to your clinic with shoulder pain and was diagnosed with a respiratory infection during their exam. The physician injected Vancomycin drug into the patient for the respiratory infection.
In this particular example, the medical coder will append modifier 25 with an E/M code for the shoulder pain and will append modifier 59 to CPT code 96372 for the administration of the Vancomycin.
See Also: Understanding CPT CODE 99211 in 2022
The Bottom Line
Medical coding for CPT code 96372 can be quite a taxing task. After all, insurers are constantly looking for ways to deny your medical claims by searching for errors in your billing codes. But your job is to make sure that all your medical claims are free of errors and comply with the ever-changing rules and regulations of medical billing and coding.