Wiki 20610 and Office Visit

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aceb911

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When I first started coding for the clinic I work for, I was always told to only charge for the 20610. In the past month, I have been asked to go back for the past year and bill Medicare/Medicaid for an office visit along with the 20610. EHR notes show that the patient only came in for a joint injection. I feel by billing for the office visit and 20610 that we are double dipping. Most commercial insurance have been denying the office visit saying that it is part of the injection charge. Anyone else have this issue when billing office visit and 20610 together?
 
CCI Edits are pretty clear on this. E&M visits and minor procedures are bundled. And if the patient came in specifically for the injection, the E&M would not be supported. I would not bill out an E&M for each one. That would send up a huge red flag.
 
I agree, do not send them out as they are definitely included and will be a red flag.

The only reason you could bill the E/M Visit is for a separate reason the patient was being seen other than the injection. And in that case, append a modifier 24

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 
Thank you for your replies. I was sure I was doing it correctly just billing for the injection. I will pass the information on to my supervisor.
 
OCD, that was a great article and just retrieved it from files that I had saved. Thanks for the reminder. We've discussed this issue greatly in the past.
 
Melissa Harris said:
I agree, do not send them out as they are definitely included and will be a red flag.

The only reason you could bill the E/M Visit is for a separate reason the patient was being seen other than the injection. And in that case, append a modifier 24

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
Click to expand...

I would use a modifier 25 in this situation instead of a 24.
 
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