Nurse observation of Patient injecting

[moremopars1]

I have a question that I am stumped by. An established patient injects himself with testosterone in the presence of our nurse. I understand that a nurse visit cannot be charged with an injection but what about the situation where the nurse only observes the injection? Also have a situation where the Doctor placed the needle but patient pushed the plunger? How would you bill the injection? Would you use a modifier 52 (reduced services since patient assisted?) I am confused and patient doesn't believe he should pay:

 

[hnroberts]

You have posed a very good question! When we are providing teaching so the patient can learn to self inject, we charge for the nurse visit, but no injection code. If your clinical staff is not actually doing the push, I don't believe you can charge for it, even if you add a modifier. I can't say I blame the patient for not wanting to pay if he is doing the injection himself, but he should be billed for staff's time. Good luck & I hope this helps some.