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cherylann.knighton

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54
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New Portland, ME
HI!
A new pt comes in for evaluation of knee pain. The provider decides to have the patient get a Kenalog injection with another provider(same practice) on the same day. I believe I can't bill for both providers (MCR pt), but not sure who I should give credit for the e/m? Thanks for your help!!
 
First is the providers in the same practice? If so I would give the Provider the PT saw the E/M code and the other Provider the injection with a modifer 25. Why wouldn't the Physican that saw the PT give the shot?
 
Sandra Fender said:
First is the providers in the same practice? If so I would give the Provider the PT saw the E/M code and the other Provider the injection with a modifer 25. Why wouldn't the Physican that saw the PT give the shot?
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The 25 modifier goes on the E&M, and you can use one claim and put the NPI of the provider that provider the service on the line in field 24J (rendering provider).. There is no problem billing this way just be certain the documentation supports the use of the 25 modifier, regardless of the fact that a different provider gave the injection the E&M documentation must be significant and separately identifiable from the injection or it is not billable.
 
Oh sorry I just reread my post and yes the modifer 25 goes on the E/M visit, sorry. thank you for correcting that for me :)
sandi:(
 
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