Wiki E/m & 90772

[kmaher]

When can you bill an E/M with modifier 25 when doing an injection of drug with 90772?

Example:

Pt goes to medexpress for poison ivy, the Dr. sees the pts and decides to give a shot of cortisone. Would you bill the E/M J-code and 90772 with mod 25 on the E/M?

 

[aclinton]

yes, the E/M would have the modifier 25 appended and then bill the J code and the 90772 admin code.

 

[dmaec]

No, the adminstration of the drug is included in the E/M - so just the E/M and Jcode (unless you're coding Medicare, then you can code the 90772 and add the .25 to the E/M Part A side)
{that's my opinion on the posted matter}

 

[zaidaaquino]

Per Medicare guidelines, physicians are instructed not to bill 99211 "on the same day as a drug administration code that has a work relateive value unit."
Payment for any E/M service the nurse routinely provides in the course of adminstering an injection is included in the appropriate injection code such as 90772.

Medicare does allow higher-level office visits to be billed on the same day as a drug administration service with -25 as long as the medical necessity is apparent.

Ex: 90772, J-code...no 99211
Ex: 99212-25, 90772, J-code (documenation must support a higher-level ov)

Hope this helps.

Zaida, CPC