CPT Code 96372

CPT code 96372 covers intramuscular and subcutaneous injections. In this article, you will learn about the introduction of 96372, description of 96372, procedure for the administration of the infusion, administration criteria for 96372, common uses of 96372, documentation requirements, modifiers for 96372, reasons for claim denials, examples of 96372, and frequently asked questions about CPT 96372.

What is CPT 96372?

The American Medical Association (AMA) introduces and maintains CPT code 96372 in the medical service category that comes under Targeted therapy, prophylactic, and diagnostic injections and infusions that are subcutaneous or intramuscular.

This code 96372 reports administering intramuscular (IM) and subcutaneous (SC) injections. The professional service of administering medications or vaccines through injections comes under this code.

The American Medical Association (AMA) describes 96372 as follows:

” Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration).”

A physician, nurse, or assistant (under the physician’s supervision) injects a therapeutic, prophylactic, or diagnostic substance (a fluid or a drug) into the patient’s body through an intramuscular or subcutaneous route.

Note: This code does not report a vaccine or toxoid injection.

The procedure associated with CPT code 96372 involves the following steps:

History taking:

The healthcare provider gets the patient’s history, assesses the patient’s condition, determines the appropriate medication or vaccine to administer, and explains the procedure to the patient.

Preparing the injection site:

The healthcare provider prepares the injection site by cleaning it with an antiseptic solution for intramuscular or subcutaneous drug administration. The healthcare professional must document the route of administration of the drug.

Administration of Injection:

The healthcare professional administers the medication or vaccine at the selected site using a sterile needle and syringe. Sterilization is important to minimize the chances of developing any infections.

Documentation:

Ultimately, the healthcare professional documents the service’s details, including the specific medication, dosage, injection site, and patient-specific considerations.

What are the reimbursement criteria for CPT code 96372?

• The reimbursement is authorized after the injection is done alone or combined with other processes permitted by the National Correct Coding Initiative (NCCI).

• While invoicing the service in combination with any Evaluation and Management (E/M) service (99201-99499) by the same service provider on the same day of the operation, additional reimbursement for 96372 will not be permitted.

Common Uses:

Common uses of CPT code 96372 in various healthcare settings and situations, including:

1. For immunizations: 96372 covers the administration of vaccines, such as influenza, hepatitis, or pneumococcal vaccines, frequently in healthcare setups.

2. For the medication administration: This code also bills the administration of medications, such as antibiotics, hormones, certain disease-related drugs, and pain relievers, either intramuscular or subcutaneous.

3. For the allergy shots: CPT code 96372 also reports billing for allergy desensitization therapy for many people, including administering allergy shots.

4. For preventive care: CPT 96372 also covers the intramuscular or subcutaneous injections used for preventive care, such as administering vitamin B12 injections.

What are the documentation requirements for 96372?

Document the following information correctly to document 96372 for reimbursement purposes:

• The type of injection, whether it is intramuscular or subcutaneous
• Site of injection
• Reason for the service
• Any allergies or adverse reactions after the administration of the injection.
• Any other services or injections on the encounter day

Also, consider the following points while documenting for 96372:

• Ensure that the injection must only be intramuscular or subcutaneous according to the guidelines for 96372. As the documentation requirements mention, properly mentioning the injection site and the method used is crucial.
• Check the modifiers and properly append them while documenting. Failure to do so may lead to claim denial.

The following are some of the modifiers:

Modifier 25:

This modifier is appended for a significant, separately identifiable evaluation and management service when an evaluation and management service performs in addition to the injection.

Modifier 59:

Modifier 59 is appended for a distinct procedural service to report a separate injection provided at a different site or during another encounter.

What are the reasons for the denial of CPT 96372?

According to the guidelines of the American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS), the following are some of the reasons for the denial of CPT 96372:

• A comprehensive evaluation service that already includes 96372.
• The healthcare provider reports 96372 in an institutional setup.
• Billing for the same treatment if the need for the service (injection/infusion) was pre-planned in a previous evaluation.
• Conduction of the service in a non-facility setup by any medical professional other than a physician, competent healthcare providers, or their supervision. CPT 99211 reports this type of situation.
• Charging for the same service twice. Report an extra E/M service with the injection if both are parallel and at the same appointment. Adequately describe the E/M service first.
• Improper recording of CPT 96372.
• Report 96372 for vaccines or injections other than those specified for this code, as most vaccines come under CPT 90471 or 90472. Assign CPT 96372 to specific vaccines and infusions.

Examples:

1. A 65 years old male patient diagnosed with pneumonia receives an intramuscular injection of an antibiotic (ceftriaxone).

CPT Code: 96372- Injection administration (ceftriaxone)

Modifiers: None

Diagnosis codes: Any relevant diagnosis

2. A patient visiting a primary care physician’s office for routine vaccination against influenza. The administration of the vaccine is through a subcutaneous injection.

CPT Code: 96372- Injection administration (fluzone)

Modifiers: None

Diagnosis codes: Any relevant diagnosis

3. A patient received a scheduled allergy shot for allergy desensitization therapy. He gets an allergen extract through a subcutaneous injection.

CPT Code: 96372- Injection administration ( relevant allergen extract)

Modifiers: None

Diagnosis codes: Any appropriate diagnosis

Frequently asked questions:

See Also

CPT Code 93306

CPT Code 99204

CPT Code 99203

97153 CPT Code

CPT Code for MRI