E/M code with weekly testosterone injections

wscallorn

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Can I bill a 99212 if my midlevel is seeing the patient and performing a review of systems and a focused based exam? She also administers the injection herself. I was taught you can not bill an E/M code if the patient is scheduled for a weekly injection based on CMS rule from 2004. Our patients are expected to return every 7-10 days. My midlevel states since she is doing the work, therefore, she should be paid for what she does. So she wants me to bill 99212-25, 96372 and J1071, who is correct? Can someone help me with this issue?
 

CodingKing

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Is there medical necessity for such a in depth exam for such a minor scheduled procedure? It seems excessive to me.
 

wscallorn

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E/M code with weekly testosterone injection

Is there medical necessity for such a in depth exam for such a minor scheduled procedure? It seems excessive to me.


In my opinion no. The patients receive their injections we supply the medications. In my opinion, the only codes should be 96372 and J1071 unless there is another problem presented at the time seen. These patients are usually in and out in 5-10 minutes. They have their vitals taken at every visit, and they go through the how are you feeling, any problems or concerns. I don't think this service warrants an office visit each week. Nothing changes other than increasing or decreasing the dosage every three months.
 

thomas7331

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If the treatment plan for this therapy requires that the provider evaluate the patient's response to the medication and make changes to the dosage periodically, I think this would support E&M services that are above and beyond what is normally involved in providing an injection (i.e. managing the underlying condition). I believe the CMS guideline you're referring to applies only to the use of 99211 with an injection, which is when the services are incident to only. In your case, if the provider feels that the patient's condition requires evaluation by the provider in person, and if this would be standard medical practice, then this would meet medical necessity too. Remember that the chief complaint doesn't have to be a new problem - it can also be a 'physician-ordered' return visit.
 
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