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Wiki Morton's Neuroma injection + office visit.

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lizzardb

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Birmingham, AL
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Has anyone had trouble getting the e&m code paid when used in conjunction with 64455? The injection is given in an office setting.
 
Is the visit for the first injection? if so did you use a 25 modifier on the visit level? If it is the subsequent injection then you cannot charge the office visit.
 
This is the first injection she's had for the morton's neuroma and we used a 25 modifier on the E&M.

Connected the office visit to morton's neuroma (355.6) and foot pain (719.47). Connected 64455 to 355.6 and J1094 to 355.6.

Does that look correct?
 
It all looks good. Several payers have trended this due to post audit that they routinely pay for one or the other, thus making you appeal to prove you have met the parameters for the use of the 25 modifier. So you will need to appeal to show your documentation.
 
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