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modifier-25 with injections

T

thurman

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3
Location
Lenoir City, TN
I just saw on MLN (March)2015 that the the initial evaluation for a minor surgical procedure is always included in the global surgery package. What if it is a new patient can the eval. be charged with modifier 25 along with the joint injection?
 
Only if it meets the criteria of significant and separately identifiable. The documentation is the determining factor along with the reason for the encounter. If the patient presents for the purpose of the injection and no other issue then no you cannot charge the E&M even if it is a new patient.
 
If it is a new patient and after the eval the determination is made to do the injection would you charge the eval. with-25 or would you need to evaluate another problem not pertaining to the injection ? I am not sure what constitutes a separate identifiable service unless it would be two problems.
 
We've had the same issue at our office. The Medicare webinar I took states that the office visit is always included in the injection and when the office visit is billed with a -25 mod with the same dx it gets denied as included in the injection. You would only append a modifier -25 if it's a whole different issue. For example patient comes in for a new visit and it is determined they need a 20611 (joint injection) for their shoulder but also their knee is examined for pain also. You would do the 20611 (-RT or -LT) with the shoulder dx and 99203-25 with the knee dx.

Hope this helps!
 
We've had the same issue at our office. The Medicare webinar I took states that the office visit is always included in the injection and when the office visit is billed with a -25 mod with the same dx it gets denied as included in the injection. You would only append a modifier -25 if it's a whole different issue. For example patient comes in for a new visit and it is determined they need a 20611 (joint injection) for their shoulder but also their knee is examined for pain also. You would do the 20611 (-RT or -LT) with the shoulder dx and 99203-25 with the knee dx.

Hope this helps!
 
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