Wiki Telehealth visit & EKG & injections done later that day

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BMWilliams

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"If a provider performs a Telehealth Visit (Audio/Video) and we bill a 99213 with appropriate place of service and modifiers and then the patient comes into the office later for an EKG or Injection, do these claims have to be billed on separate claims? Can they be billed on the same day at all?"

Our Dr. is getting paid for his telehealth office visits but not the ekg's and injections. We have a 25 with a 95 on the 99213 and no modifiers on the procedures. We are billing place of service office.
 
Is the EKG inclusive to your E/M? If so, I'm thinking that with the E/M with an inclusive EKG and injections, the E/M keeps the 25 modifier and the injections may need an XU modifier. If there are multiple injections they may need laterality and/or XS modifiers depending on what the injections are specifically.
 
Hi there, modifier 25 is not appropriate in this scenario. You'll need to check the bundling edits for the specific services performed on the day of the E/M encounter to determine whether the services are bundled into the E/M encounter and then determine whether it would be appropriate to report those services with modifier 59.

Review the full descriptors for modifier 25 and 59 in Appendix A of your CPT manual.
 
This is interesting, because we (the company I currently work for) have been coding it this way without issues. Advised for superiors to do so. I'll have to talk to them about this, so thanks for chiming in!!
jkyles@decisionhealth.com said:
Hi there, modifier 25 is not appropriate in this scenario. You'll need to check the bundling edits for the specific services performed on the day of the E/M encounter to determine whether the services are bundled into the E/M encounter and then determine whether it would be appropriate to report those services with modifier 59.

Review the full descriptors for modifier 25 and 59 in Appendix A of your CPT manual.
Click to expand...
 
jkyles@decisionhealth.com said:
Hi there, modifier 25 is not appropriate in this scenario. You'll need to check the bundling edits for the specific services performed on the day of the E/M encounter to determine whether the services are bundled into the E/M encounter and then determine whether it would be appropriate to report those services with modifier 59.

Review the full descriptors for modifier 25 and 59 in Appendix A of your CPT manual.
Click to expand...
 
Thank you. I believe the biggest issue is that the E-M was a Telehealth (audio/Video) and the pt came into the office later to have the EKG &/or and injection. This may be an issue that will have to go to appeals to show that the EKG was done at a different time & not during the telehealth visit.
 
BMWilliams said:
Thank you. I believe the biggest issue is that the E-M was a Telehealth (audio/Video) and the pt came into the office later to have the EKG &/or and injection. This may be an issue that will have to go to appeals to show that the EKG was done at a different time & not during the telehealth visit.
Click to expand...
To clarify, I don't believe how the E/M visit was performed is relevant. If this was a face-to-face visit that started as an E/M and the physician decided to perform additional tests/procedures during that encounter you'd unbundle the procedures (if possible). I think this is reflected in the full descriptors.
 
We are having the same issue. We are a small STI clinic and our provider does two days as mixed virtual. He is on video but the patient comes in for their lab work, vaccines, injectable HIV medications. When it is just an injection visit with no face time to provider we have no problem, we bill injectable with admin code and get paid. If the provider does a virtual visit, we are not getting paid for the in office injections, tests and some labs. Would we be able to do a split claim for the same provider?
 
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