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Billing Drug and Administration Together Remember, 96372 is the administration code

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Denial patterns appear when: Functional impairment is missing from the record Objective strength findings are absent Repeated use continues without updated findings or diagnostic clarification ICD-10 does not support the intensity/type of billed services Medicare and Payer Perspective on M62.81 Medicare and commercial payers expect: Objective findings supporting weakness functional limitation supporting treatment progression tracking when services continue over time diagnosis refinement when evaluation identifies a cause Common payer red flags: weakness was stated only in the subjective section No strength testing was documented therapy billed without functional goals tied to deficits M62.81 was used repeatedly without an updated assessment Common Claim Denials Linked to M62.81 Denials typically tie to documentation gaps rather than the code itself: Missing objective strength findings Missing ADL or mobility impact Weak plan-of-care connection to billed services Non-specific coding when a specific cause is documented elsewhere in the record No progress reporting for continued therapy Denial prevention comes from structured charting, consistent reassessment, and CPT-to-diagnosis alignment