Wiki E/m with injection


Escondido, CA
Best answers
I am seeing more denial for E/M when billed with injection. Insurance is paying for the injection and denying the E/M with a 25 modifier stating procedure is included in the value of another procedure performed on this date. I was thinking on using XU modifier on the injection code. Does anyone have any thoughts? I do appeal and end up getting paid but would like some thought on this.
This is standard operating procedure for insruance companies

First of all, insurance companies don't "process" claims anymore. The claim is sent electronically and if anything hits an edit the computer denies it. I know that no one is looking at them because if you looked at the diagnosis codes and modifiers you could easily tell that both codes are allowed. Such as an injection on the right shoulder (20610) after a RTC repair on the left shoulder. Insurance companies will deny that every time forcing you to appeal. I have never found a coder that has found the magic needed in order for insurance companies to actually "process" claims and not just let the computer deny a charge and totally ignore the diagnosis codes and modifiers submitted. I think your stuck appealing these with medical records to show that both are allowed.
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