Wiki Does New Patient E/M require Modifier -25 with injection?

KStaten

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Hello Everyone! :)

I have a quick question, as I am seeing conflicting information. Does a new patient E/M require Modifier -25 when the patient receives an injection on the same day?

Example) New patient is evaluated, diagnosed with right knee osteoarthritis, and receives an injection (methylprednisolone) into his/ right her knee. Does the E/M code need modifier -25?

99203 -25 (?)
20610 RT
J1030



Thank you in advance,

Kim
 
We do use the 25 modifier. My provider spends two hours face-to-face with a new patient (pain specialty), to determine how they ended up with chronic pain, what's been tried and failed, etc. There is no way that is part of a knee injection.

If we were a walk-in clinic or a general medical practice, I might do things differently, depending on what the doctor did.
 
From the information you are presenting, looks like a modifier 25 would be used. If I code for a new patient and this procedure was not planned and Dr. decided to perform an injection during that visit, I would add the modifier 25. If an established patient comes in unplanned(not planning to have a procedure done) and presents with a new problem that leads to a procedure , I also use modifier 25 on the E/M.
 
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By the way, our Blues won't pay for injections with an E&M. They changed their policy last year. So we changed ours... no injections with E&M.
 
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