Billing 99211 along with 99213/99214


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I have been researching whether or not 99211 and 99213/99214 can be billed together (adding modifier 25). Recently I was told that if a patient comes to see the physician he can bill 99213/99214 then if his/her nurse has to see the patient to administer an injection that is considered a separate service so they suggested billing 99211. I have viewed the CCI edits, Medicare guidelines and cannot locate anything that states the two codes can't be billed together. I disagree with the person who told me this except they have stated to me that she received this information from another source who is billing this way. Any input, suggestions or comments are greatly appreciated. :confused:


True Blue
Modesto, CA
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You would not bill two E&M services for the same visit. If the nurse administers an injection such as:

Vaccine Administration
90460 – 90461 Immunization with counseling for 18 yrs and younger
90471 - 90473 Immunization administration
G0008 – G0010 Immunization administration Medicare Only

Therapeutic Injections
96372 – 96376 Therapeutic/Prophylatic/Diagnostic Injection

When a medically necessary, significant and separately identifiable E&M service is performed, in addition to a drug and/or vaccine administration service, the appropriate E&M CPT code should be reported with modifier -25 to allow payment for both E&M and administration services.

Patient seen for fatigue, headache and pernicious anemia. Patient receives B12 by injection for the pernicious anemia. The billing would be:
o E&M with a modifier 25 and a fatigue, headache, and pernicious anemia diagnosis
o 96372 and a diagnosis of pernicious anemia
o J3420 for B12 injection and a diagnosis of pernicious anemia


True Blue
Best answers
No you cannot bill 2 E&M's. If the nurse is performing an injection ordered by the physician its included in the Physician E&M under normal Incident to guidelines. If it was already scheduled you can't bill E&M separately because its bundled into the injection procedure.