Wiki unbundling

[fcctn-2008@yahoo.com]

Hello,

Patient comes in for a sick visit and the provider ordered injection J1100 and J3301?
do you add the admin fees and modifier 25 too?

 

[rstroup]

We always bill an E/M with modifier 25 and 96372 as long as there is clear documentation showing an HPI, Exam, Assessment and Plan. Since you gave 2 injections, use 96372 X 2 units. Where you would NOT bill an E/M is when the injection is planned, such as a patient who comes in every 3 months for a Depo shot - unless there is a significant, unrelated problem that is also addressed during the encounter.

--
Ryan Stroup, CPC

 

[fcctn-2008@yahoo.com]

We always bill an E/M with modifier 25 and 96372 as long as there is clear documentation showing an HPI, Exam, Assessment and Plan. Since you gave 2 injections, use 96372 X 2 units. Where you would NOT bill an E/M is when the injection is planned, such as a patient who comes in every 3 months for a Depo shot - unless there is a significant, unrelated problem that is also addressed during the encounter.

--
Ryan Stroup, CPC

Thank you