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Therapeutic injections during an e/m

Melissa_M

Guest
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40
Location
St. George Utah Chapter
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We have always billed a -59 on the 96372 when performed during an e/m (other than 99211). Example: 99213, -25=401.1, 480.9
96372, -59=480.9
J3301 x4 units=480.9

We are now part of a large group of providers and are being told that we can not bill as above. We receive payment for the 96372. What are your thoughts?

Thanks,

Melissa
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
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2
you do not need a 59 on the 96372 only a 25 on the E&M. If only an injection is performed then only the 96372 is billed, never a 99211 instead of or with the 96372.
 

ringalls

Networker
Messages
44
Location
Bristol, NH
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0
Debra Mitchell is correct you will not need a modifier -59 on the 96372, although id you are charging a 96374 with a 96372 you will need a modifier on the IM injection
Robin Ingalls-Fitzgerald, CCS, CPC, FCS, CEMC, CEDC
Medical Reimbursement Specialists
 

ollielooya

True Blue
Messages
900
Location
Everett, WA
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clarification, please...
So IF the EM is billable and if a 96372 AND 96374 are performed, a modifier WOULD need to be attached to the 96372 as in: 99213-25, 96374, 96372-59. Is this correct? Suzanne E. Byrum, CPC
 

armen

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335
Location
Atlanta
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clarification, please...
So IF the EM is billable and if a 96372 AND 96374 are performed, a modifier WOULD need to be attached to the 96372 as in: 99213-25, 96374, 96372-59. Is this correct? Suzanne E. Byrum, CPC
What they are saying is that you do not need to attach 59 to any code billed with and E/M if it is the only code billled in addition to an E/M, only 25 for E/M to unbundle an E/M. You need to attach 59 to 96372 since there is a CCI edit bundling it with 96374.

And you need to bill an E/M only if there really was an E/M and not just a regular pre-op which is part of any surg proc. The use of modif 25 woudl not be justified then.

So E/M-25 + 96372 or E/M-25 + 96372-59 + 96374
 
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