Our clinics pose the same question to me all the time. My advice to them is that if the patient comes in with a new problem or is a new pt to the provider and treatment evolves into an injection, modifier -25 is probably justified (for that visit only)----probably. however, if its an established patient with an established problem/symptom and the office visit is simply to get a repeat injection/treatment, i would say only the injection is billable. keep in mind there is a small amount of an e/m service in all procedures.
Other things to consider is:
-did the provider mention in the previous visit note that he intended on treating the patient with an injection/treament at the next visit? if so, i would say the injection is the only billable charge.
-are there any changes in injection dosage? if so, chances are there was a minor complication or pt isnt responding appropriately therefore requiring a more detailed history/exam which would probably support an office visit charge and an injection.
-documentation also plays a key role in this. if the provider is not a clear documenter, modifier -25 may never be supported. on the flip side, if the provider is a good documenter or overdocuments, modifier -25 will probably always be supported but that is when medical necessity comes in to play.
Good luck....its a tricky area!! its not one of those black or white areas....there is always some grey.
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