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Wiki Billing for E/M and Injection on same day.

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kguzikowski

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Muskego, Wisconsin
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Patient is seen in the Office E/M 99213 would add modifier 25-Patient was seen by PA.
During that same visit patient receives and Injection given by the RN or Medical Assistant.
Can the Injection piece of the visit be billed under a physician instead of billing under the PA who provided the E/M service.
 
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If the services provided by the RN/MA meet incident-to, then you may bill under the physician. If the MD did not order the injection or is not onsite, I would bill the injection under the PA.
 
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If there was a significant and separately identifiable visit, then -25 on the E/M is appropriate (assuming the E/M and injection are NCCI edits requiring a modifier to override).
 
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On ED coding, billing both the ED facility e/m and the professional e/m for the visit while providing the injection 96372 (or other procedure such as inhalation treatment 94640), would the 25 modifier be needed on both the facility e/m (rev code 450) as well as the professional e/m (rev code 981)? Or, is the modifier 25 only needed on the facility level?
 
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You can bill the E/M with modifier -25 on the injection if one of the following is true:
  • The problem the injection is treating is different than what was addressed in the E/M visit
  • During the course of the visit, the provider decides an injection is needed to treat the presenting problem
  • The patient is scheduled for the injection and says "btw, totally separate issue" and the E/M addresses that issue
If the patient was scheduled for an injection, the E/M work involved is already included in the injection code.
 
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kdlberg said:
You can bill the E/M with modifier -25 on the injection if one of the following is true:
  • The problem the injection is treating is different than what was addressed in the E/M visit
  • During the course of the visit, the provider decides an injection is needed to treat the presenting problem
  • The patient is scheduled for the injection and says "btw, totally separate issue" and the E/M addresses that issue
If the patient was scheduled for an injection, the E/M work involved is already included in the injection code.
Click to expand...
If nursing administers, is the 25 to go on both facility e/m level and professional e/m level or only facility?
 
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