Repeat Injections with E/M Codes

KStaten

Networker
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Charleston, West Virginia
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Greetings Fellow Coders! :)

Scenario: A new patient is evaluated and found to have OA of the left knee. On that visit, the physician decides to perform an injection and bills an E/M (99203) with a modifier 25. At that visit, the physician does not "plan" another injection.

If the patient returns three months later
and the physician decides to perform another injection at the time of that visit, can an E/M be billed? If not, under what circumstances could an E/M be billed? (For example, if the drug and/or dosage changes, if the condition worsens, if "X" amount of time has passed, if x-rays and/or other imaging reports are ordered/ reviewed, etc., would any of these factors allow for an E/M to billed?)

Thank you all in advance,

Kim
 

Orthocoderpgu

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Salt Lake City, UT
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Under these circumstances it's normal not to plan another injection. The doctor is going to want the patient to follow up and will find out then if it worked, if so for how long, not work at all. You don't normally plan another injection in this case. Keep in mind that O/A is a chronic condition and you don't expect it to "improve" like you would other medical conditions. You can treat the pain but the condition is going to progress over time. Also keep in mind that every surgical procedure code, yes even the lowly 20610 has a "built in" E/M component to it. You would have to review this on a case by case basis but once someone has O/A and you know its going to progress (the only question will be how fast), how much medical decision making is needed to have another injection? In this case usually not much. A change in the medication used or the amount may play a part, and may support a separate E/M depending on the circumstances especially if the patient gets almost no relief from the initial injection.
 

klienhart

Networker
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When a patient receives an injection, you typically cannot bill for an E/M for six months, unless the patient is being seen for an unrelated issue.
 
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