Wiki E/M coding with procedures

[syrobinson]

I was wondering if anyone codes an E/M rather than an injection. The RVU for E/M is higher in some cases than the injection RVU and I can't always justify an additional E/M using the 25 modifier.

 

[thomas7331]

I don't think that anyone has a choice in the matter - you can only code the service(s) that the documentation supports. E/M services and injections are two different things. If the documentation is for an injection, it can't be coded as an E/M simple to get a higher RVU.

 

[syrobinson]

The provider documented the visit, it just doesn't qualify to add the "25" modifier

 

[CodingKing]

Right because the E&M Isn't significant and separately identifiable. There is a minor E&M component built into all surgical procedures. You don't just blindly stick and run. You must use the code that most accurately describes the procedure and that is the injection. Using E&M in its place would be upcoding, which is considered an abusive if not fraudulent billing procedure (since you know better)