Question E/M being bundled

strusty

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We are seeing payments from insurance companies that are bundling the E/M when the patient also receives an injection (90673). The injections are either for Depo, Toradol, pretty much any J code. Any idea's .
 

Pam Brooks

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90673 is the code for influenza vaccine. Do you mean 96372, for an IM or SQ injection administration code?
The E&M is bundled. Add a -25 only if the E&M is significan and separately identifiable, but they still may not pay.

NCCI Edit Results:
Edit exists with 96372. 99214 is a Column 2 code. If both 96372 and 99214 are submitted, only 96372 will be paid.
- This edit CAN be overridden via CCI-associated modifiers WHEN APPROPRIATE.
- Rationale: Standards of medical / surgical practice
- Effective 10/1/2020
 
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