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

[KStaten]

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

 

[Leandra]

I would refer you to the link below; CMS (for the most part) considers the E&M portion inherent to the minor surgery (20610), even for new patients. I would check with the payer to see if they follow Medicare guidelines or do they have their own distinct guidelines for these scenarios.

https://www.aapc.com/blog/46811-be-careful-when-separately-reporting-e-m-and-minor-surgical-procedures/

 

[SharonCollachi]

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.

 

[KRZollinger67]

We bill for Urgent Care and do add the -25 modifier on the E/M level.

 

[pwebbabshire@cox.net]

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.

 

[SharonCollachi]

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.