When to use CPT code for B12 injection

Their has been lot of confusion with the coding of B12 injection. This has happened because many coders are not aware of use HCPCS codes. Each CPT or HCPCS code has particular guideline and coder should always follow those guidelines. If you do not follow guidelines then your coded procedure might be not paid or denied by the payer. Same happens with the cpt code for b12 injection procedures.

Let use first know about the exact HCPCS code used for coding B12 injection.

J3420  Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg

Read also: When to use Vaccine Administration G codes

Things to remember while coding J3420 CPT code for B12 injection

Vitamin B ₁₂ is essential for the formation of red blood cells and is used in the treatment of diseases in which there is defective red cell formation.

Vitamin B₁₂ administration by injection is a covered benefit accepted as medically necessary when the beneficiary has a history of a low serum B₁₂ or conditions causing or caused by a low serum B₁₂.

In addition, vitamin B₁₂ will be considered medically necessary when administered as an adjunct to Alimta® or Folotyn™ treatment as follows:

• For Alimta® patients, patients must receive one intramuscular injection of vitamin B₁₂ during the week preceding the first dose of Alimta® and every three cycles thereafter 
• For Folotyn™ patients, supplement patients with vitamin B₁₂ 1 mg intramuscularly no more than 10 weeks prior to the first dose of Folotyn™, and every 8-10 weeks thereafter 
• Subsequent vitamin B₁₂ injections may be given the same day as either Alimta® or Folotyn™

Vitamin B₁₂ injections (J3420) used to strengthen tendons, ligaments, etc. of the foot are considered investigational and are therefore noncovered.

Subcutaneous and intramuscular injections should be reported with code 96372 in addition to the code that identifies the medication injected. Vitamin B12 should be reported with code J3420, which represents up to 1,000 mcg per unit.

Now, it is very important to check the payer guidelines before billing mutiple B12 injection. Some payer may not accept more than 1 injection in a month of B12, unless a verified medical documentation.

Also, CPT code 96372 can be enough for administration of drugs and includes the injection of drugs for some payers. Hence be careful with the payment of CPT code for b12 injection.

96372 –Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

Also, their are some supported diagnosis which are only paid for CPT code of B12 injection. Hence, it is very important also look for the supportive medical diagnosis (ICD 10 code) to fulfill CPT code for b12 injection.

Read also: CPT/HCPCS  status indicators for Medical coders

ICD-10 Codes supporting CPT code for B12 injection (J3420)

D51.0 – D52.9 – Opens in a new window Vitamin B12 deficiency anemia due to intrinsic factor deficiency – Folate deficiency anemia, unspecified
D53.1 Other megaloblastic anemias, not elsewhere classified
D53.9 Nutritional anemia, unspecified
D81.818 – D81.819 – Opens in a new window Other biotin-dependent carboxylase deficiency – Biotin-dependent carboxylase deficiency, unspecified
E40 – E42 – Opens in a new window Kwashiorkor – Marasmic kwashiorkor
E44.1 Mild protein-calorie malnutrition
E45 Retarded development following protein-calorie malnutrition
E46 Unspecified protein-calorie malnutrition
E53.8 Deficiency of other specified B group vitamins
E64.0 Sequelae of protein-calorie malnutrition
G32.0 Subacute combined degeneration of spinal cord in diseases classified elsewhere
K29.30 Chronic superficial gastritis without bleeding
K29.40 Chronic atrophic gastritis without bleeding
K29.50 Unspecified chronic gastritis without bleeding
K86.0 – K86.1 – Opens in a new window Alcohol-induced chronic pancreatitis – Other chronic pancreatitis
K90.0 – K90.49 – Opens in a new window Celiac disease – Malabsorption due to intolerance, not elsewhere classified
K90.89 – K90.9 – Opens in a new window Other intestinal malabsorption – Intestinal malabsorption, unspecified
K91.1 Postgastric surgery syndromes
K91.2 Postsurgical malabsorption, not elsewhere classified
T50.995A – T50.995S* – Opens in a new window Adverse effect of other drugs, medicaments and biological substances, initial encounter – Adverse effect of other drugs, medicaments and biological substances, sequela