Wiki E&M and Joint Injections perfomed during same session CCI issue

[chasidyh@hotmail.com]

Are we allowed to bill an E&M (99213) along with 20610 or even a trigger point (20552) during the same session as an office visit. My EHR is telling me there is a CCI issue. We have place modifier (25) on our EM. Can't seem to find anywhere about a CCI update relevant to this issue. Thanks!

 

[apollo06]

If the office visit is for a seperate issue other than the joint injection....yes you may code a E/M. If the patient is coming in for the injection only, then no you may not code a E/M with it.

 

[LaVoncye]

seperate dx codes

Make sure you are not using the same DX code for the EM visit and the injection. You have to show that the reason for the OV was outside of the reason for the injection, separately identifiable by the DX code used.

 

[dwaldman]

The fact that the "problem list" in the EHR. has the past ICD-9 codes the patient was seen for can sometimes result in the checking of past conditions that might not have any active treatment plan during the encounter but the patient does possess the condition and might be managed by their PCP or is currently not a primary complaint. What has to be reviewed is what is being provided to the patient for that condition to warrant additional evaluation and management above and beyond the typical patient encounter prior to an injection.

I personally will not bill a follow up visit regardless of the circumstance in addition to injection. Pain management for chronic pain can have ongoing visits over years with management of the prescription medications and when it is an injection then it is billed as such and when it is an office visit it is billed as such but never both. I find the guidelines too loose for my comfort, for me it is almost like trying to determine if it is a consultation or not. There are many angles to look at it and I choose to pick the most conservative one. And leave the audits and denials to less subjective determinations.

Below is from the NCCI policy manual for proper use of the 25 modifier

b) Modifier 25: The CPT Manual defines modifier 25 as a “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service”. Modifier 25 may be appended to an evaluation and management (E&M) CPT code to indicate that the E&M service is significant and separately identifiable from other services reported on the same date of service. The E&M service may be related to the same or different diagnosis as the other procedure(s). Modifier 25 may be appended to E&M services reported with minor surgical procedures (global period of 000 or 010 days) or procedures not covered by global surgery rules (global indicator of XXX). Since minor surgical procedures and XXX procedures include pre-procedure, intra-procedure, and post-procedure work inherent in the procedure, the provider should not report an E&M service for this work. Furthermore, Medicare Global Surgery rules prevent the reporting of a separate E&M service for the work associated with the decision to perform a minor surgical procedure whether the patient is a new or established patient.