Wiki E/M with injection

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millerams

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If a patient come in with dx of bronchitis and is given a Kenalog injection. Can the following codes be filed with Medicare and other carriers? 99212w/ 25modifier 96372 and J3301. I am just not sure and dont want to do anything wrong.

Thanks

Jennifer
 
E/M with injections

Would you still bill it this way even if the DX is the same for all the procedure codes?

TIA
Gina, CPC, CEMC
 
hthompson said:
Does everyone bill a mod -25 for a 99212, 96372, J3301?
Click to expand...

Well, only if the documentation supports it.

If the patient had an office visit the previous week and is returning for the injection, then no, you wouldn't bill an office visit.

If the patient came in because of knee pain, the MD did a full workup, and decided to give the injection while the patient was in the office, then that would qualify for a separately billable E/M service, assuming the documentation was there.

It's a situational thing.
 
I just never envisioned a 96372 as a -25 appropriate code. I'd stick it on 20610 in a heartbeat, given the situation that it supported it, but it never once entered my mind that 96372 qualified.
 
I think it's because all the coding classes I've attended, put some weight on the description.

-25 Significant, Separately Identifiable Evaluation and Management Service by the
Same Physician on the Day of a Procedure

I don't see anything "significant" about a therapeutic injection. It's a poke in the arm, etc. Separate yes, but not significant.

I do see it as significant for a TPI or joint injxn, because that takes more skill and a dr does it.

Help me see what you're seeing :)
 
OK, that makes more sense :)

Anytime you bill a procedure code along with an E/M code, you need a mod-25, even if it's a realtively simple procedure, such as 93672.
 
What the UHC policy is saying that 96372 already includes payment for the E/M service that lead up to the decision for the injection. This is standard CPT conventions. All procedure codes include an E/M service by definition. It's part of the global surgical package.

My point was that if you provide a separately identifiable E/M service in addition to the workup for the injection, then you can bill that E/M code with a mod-25 so that they will know it is separate from the E/M service provided as part of procedure. That is the purpose of mod-25.

If you do not have a separately identifiable E/M service in addition to the injection, then you do not bill an E/M service at all. You would just bill the 96372 by itself.

Maybe i'm not explaining this clearly.. someone help me out here!
 
I think I hear you saying that if the visit qualified for a 99212 and an injection was performed (96372), then no matter what, (given there is appropriate documentation), a -25 would be appended to the 96372.

My point was that I've never used a 99212-25 with my 96372. In my trainings, it was very strongly addressed that it had to be a "significant" separate, identifiable E/M. I didn't think a shot was significant. Even if the 99212 was for something else.

I think I am understanding now (after reading and a lunch break :)) that it's not the procedure that needs to be significant, it needs to be the E/M that is significant enough to warrant a code which then needs a -25.

Sorry for confusing you, I think I confused myself more than I confused you! :D
 
hthompson said:
I think I hear you saying that if the visit qualified for a 99212 and an injection was performed (96372), then no matter what, (given there is appropriate documentation), a -25 would be appended to the 96372.
Click to expand...

No... mod-25 is never appended to a procedure code, only to E/M codes.
 
hthompson said:
I think I am understanding now (after reading and a lunch break :)) that it's not the procedure that needs to be significant, it needs to be the E/M that is significant enough to warrant a code which then needs a -25.
Click to expand...

Now you got it! The mod-25 is telling the payer that you are billing for an E/M visit that is in addition to the one that is already included in the 96372. If you do not put the mod-25 on it, they will bundle the E/M encounter with the injection and you will not get paid separately for it.
 
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