Health Information Management

Q/A: No MUE limits published for 96372

APCs Insider, March 26, 2010

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Q. Our question pertains to CPT code 96372, which denotes therapeutic, prophylactic, or diagnosis injection (specify substance or drug); subcutaneous or intramuscular.

A physician orders one dose of a medication to be administered intramuscularly (IM) or subcutaneously (SQ). The volume required for this dose exceeds the amount recommended for a single injection, so the nurse must divide the dose into two IM/SQ injections. May we report one or two units of 96372 for this service? What is the maximum number of units with the same date of service that providers may report to Medicare? We experience edits when we report this procedure with multiple units.
 
A. Report the multiple IM/SQ injections with 96372. A test in the stand-alone NTIS OCE grouper version 11.0, using 96372 x 2 and a J code with a fictitious date of service for 2/1/2010 did not produce any edits from the OCE grouper.
 
In some cases, encoder software (e.g., 3M) in your coding department may be loaded with edits developed by the encoder developer and not an OCE edit from CMS.
 
Please review the edit and ascertain whether the edit is created by CMS or via the encoder software developer.
 
Although medically unlikely edits (MUE) exist for other drug administration codes, CMS has not published MUE limits for 96372.
 



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