Home Forums Discussions Coding and Billing Billing and Coding Help

Hi,

My name is Ben Hoffman and recently I have been put in charge of bringing billing in house. Basic stuff has been going good but running into some problems.

One huge question is this:

When i have a office visit 99214 and the patient has a vitamin b deficiency we then do an injection of Vitamin B-12 (J3420). What code do i use to charge for the injection administration? I was using (96372), but i am getting errors in Advanced MD for that.

Another question i have is what do you charge for:
82948 - Glucometer
87430 - Strep Test
81002 - Urinalysis by dip


Also for Hospice - how do you bill that? We have physicians not employed by the nursing home checking on them.


Thanks so so much!

Ben

I have never been successful at getting paid for a B12 injection at the time of an office visit. My patients know this and are required to come in for their shots separately

Ben, we have not had success in getting paid for the B12 either. But, do add a 25 modifier to the E&M code. The code you're using for the injection admin is correct.
As for deciding what to charge for your other tests, you might try going to your Medicare carrier website and checking their fee schedule for the particular codes. Then you can decide what percentage you want to apply to that for your commercial payers. Your contract with your commercial payers should indicate what percentage of medicare they pay for labs and drugs. I have heard the rule of thumb that your fee should be 20% higher than your best payer's reimbursement.
Also, with regard to which of the Hospice modifiers to add to your claims, there is a good decision tree on the Trailblazer Health Website. Even though this might not be your medicare carrier, you may still be able to check it out. Good luck with all this!

We have no problem getting paid for the visit and the injection fee. We don't bill for the B12 itself. We use a -25 modifier on the visit, and injection code 96372. I write rx for B12 and patient brings their own from the pharmacy, I keep it in the office to use for them.

Just checked with my billing - Medicare is paying the injection code OK and a whopping 30 cents for the B12.

Which is why we don't bother billing the B12.

You realize that if the 2% cut from the debt reduction passage goes through, you may only get 29 cents.

And my cost for the B12 is like $1.30 with all the recent production shortages.

Thanks guys for all the help.

Here is a issue i have:

I bill for a 99214, J3420, and 96372. Where would i put the 25 modifier? On the 99214 or 96372.

We got one back from BCBS and they only paid for the J3420 and the injection, ignored the 99214. Not good.

Thanks!

Ben

Ben, re: hospice billing, in procedure code- add modifier GW. Also add description in field 19, "Attending physician not paid or employed by hospice provider."

Add modifier -25 to the 99214 to indicate a separate service.

Thanks guys so much!

I have one more question.

When we do just a J3420 (no office visit) i was using this code for administration 96372.

I get this error message:

An E/M service should not be billed on the same date as Hx Procedure 96372,(THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM) on Visit #251910, Line #3 unless circumstances warrant use of a modifier -25 or -57.

Any ideas why that would be?

Thanks so much!

Ben

Sorry for so many questions. When i use the modifier which box of the four do i put it under?

The first DX box or the dx for b-12 deficiency?

Thanks!

Ben

Ben,
You don't put modifiers in the diagnosis boxes, you put them on the line next to the service codes. Look on the CMS 1500 form and you'll even see the header "modifiers" above where it goes. Sounds to me like you might benefit from bringing in someone in, maybe even just a consultant to get you set up who can show you how to code.
Amber