Wiki antibiotic inj and ofc visit

[swelch]

Hi, I have a scenario in question--pt came in-dx pneumonia--e/m code 99213 ---j0696 inj. given with 96372 --use 25 mod on e/m.
next day pt returned. charges were the same--the ins. denied the 99213 but pd j0696 and 96372 on second day. plz advise !!

 

[hudiknight]

Probably not enough E/M documentation to warrant a 99213 one day after billing it. Did the doctor really do another 99213 the very next day (HPI, exam, ROS, MDM, etc) that was medically necessary?