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Reader Question: CCI Edits Direct Whether 96372 Is Allowed With Scope

Posted on 18. Mar, 2015 by in Coding Challenge

Question: When the otolaryngologist performs a scope in the office and also gives a shot (using 96372 for administration and a separate code for the medication), is there any reason to put a modifier on the administration 96372 code? 

Nebraska Subscriber

Answer: Yes, for some reason, CCI (Correct Coding Initiative) has bundled therapeutic injections with diagnostic endoscopies.  So, you need to append modifier 59 (Distinct procedural service) to 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) since the coding edits classify 96372 as included in the scope procedure.

For example, 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) includes 96372, per CCI edits. You would need clear documentation of the separate services before reporting both codes and would append modifier 59 to 96372. Code 96372 is bundled into all three diagnostic endoscopies performed in the office: 31231, 31575, (Laryngoscopy, flexible fiberoptic; diagnostic) and 92511 (Nasopharyngoscopy with...

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