E/M & Injection same day

KoBee

Guru
Messages
220
Best answers
0
I have an orthopedic provider who keeps billing and E/M with CPT 20610, most of the time they are prescheduled injections and wants to justify the E/M by stating patient continues or still has pain in chief complaint. There isn't no new problem or any other significant exacerbation.

If patient continues to have pain, is that enough to consider a separate E/M every time the patient comes to get injection?

Would like hear if others run into this situation and I want to make sure this is enough to warrant an E/M. Thank you
 

gjja

Networker
Messages
29
Best answers
0
I agree. I constantly see orthopedists trying to unbundle the E/M and the injection, but I don't allow it on audit unless it is a separate and distinct reason for the E/M. As mentioned above, a different body part/issue would be separate and distinct.
 

KStaten

Networker
Messages
65
Location
Charleston, West Virginia
Best answers
0
I posted a similar question to this yesterday. If the physician changes either the medication or the dosage being administered (but treatment is the same condition/ same body part), would that be enough to justify an E/M? Also, what are your thoughts on the amount of time which has passed between injections? For instance, if it has been 6 months, 1 year, 2 years, etc, is there a point where re-evaluatiing a patient's condition (such as OA) would justify an E/M? Thank you! I appreciate everyone's input!
 

Jessim929

Guru
Messages
153
Best answers
0
We have similar arguments with our (Urology) physicians. We tell them that if they're doing the procedure for one specific reason and any discussion is directly related to the procedure or its findings, its not a visit. (my first criteria when I review those is if the visit can stand alone without the procedure, then I go further into review.) If the patient comes in with a new complaint "since I was coming to see you anyway" - you know there's ALWAYS THAT patient - :) they can do a visit.
 
Top