Wiki joint injection charges

[desertsteph65]

In Part B Medicare news this past week is an article about charges for injections.

The way I am interpreting it: you cannot charge for an office visit and an injection on the same day.

Has anyone encountered this yet??

 

[dede470]

Yes, the orthopedics office I used to work at, we would Not charge an office visit if the patient was coming in for their 2nd, 3rd,4th shot of Orthovisc, Supartz, etc.... We noticed if the patient was only coming in for that procedure, the office visit was denied. Especially with all the Medicare plans.

 

[OCD_coder]

Source:

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
Chapter 1, page I-18 and 19

You can bill for an office visit only if it is either "significant" or "separate" from any minor procedure performed on the same DOS. Coder's will need to be more savey in determining scenarios that could be considered "significant" such as; if x-rays are performed, a prescription medication is given for a treatment plan other than postoperative pain management, maybe there is a significant discussion regarding surgical options. Simply making the decision to perform the minor procedure is not enough to bill a separate office visit with a minor procedure.

If the provider performs a service for a totally separate problem for example the contralateral knee to the one receiving the injection, the documentation should support two distinctly separate services.

Use the sharpie test:
Cross out all information having to do with the body area where the procedure takes place and if there is documentation left to support an E&M with medical decision making then a E&M CPT code might be supported.

It's better to error on the conservative side.