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E/M with injection

  1. #11
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    Medical Coding Books
    I'm saying 99212-25, 93672 versus 99212-25, 20610; not putting it directly on the procedure code.
    Heidi Thompson, CPC

  2. #12
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    OK, that makes more sense :-)

    Anytime you bill a procedure code along with an E/M code, you need a mod-25, even if it's a realtively simple procedure, such as 93672.
    Walker Bachman, CPC, CPPM

  3. #13
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    Quote Originally Posted by Walker22 View Post
    OK, that makes more sense :-)

    Anytime you bill a procedure code along with an E/M code, you need a mod-25, even if it's a realtively simple procedure, such as 93672.
    This memo from UHC, doesn't agree:

    https://www.oxhp.com/secure/policy/t...ction_109.html

    Any opinions?
    Heidi Thompson, CPC

  4. #14
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    What the UHC policy is saying that 96372 already includes payment for the E/M service that lead up to the decision for the injection. This is standard CPT conventions. All procedure codes include an E/M service by definition. It's part of the global surgical package.

    My point was that if you provide a separately identifiable E/M service in addition to the workup for the injection, then you can bill that E/M code with a mod-25 so that they will know it is separate from the E/M service provided as part of procedure. That is the purpose of mod-25.

    If you do not have a separately identifiable E/M service in addition to the injection, then you do not bill an E/M service at all. You would just bill the 96372 by itself.

    Maybe i'm not explaining this clearly.. someone help me out here!
    Walker Bachman, CPC, CPPM

  5. #15
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    I think I hear you saying that if the visit qualified for a 99212 and an injection was performed (96372), then no matter what, (given there is appropriate documentation), a -25 would be appended to the 96372.

    My point was that I've never used a 99212-25 with my 96372. In my trainings, it was very strongly addressed that it had to be a "significant" separate, identifiable E/M. I didn't think a shot was significant. Even if the 99212 was for something else.

    I think I am understanding now (after reading and a lunch break ) that it's not the procedure that needs to be significant, it needs to be the E/M that is significant enough to warrant a code which then needs a -25.

    Sorry for confusing you, I think I confused myself more than I confused you!
    Heidi Thompson, CPC

  6. #16
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    Quote Originally Posted by hthompson View Post
    I think I hear you saying that if the visit qualified for a 99212 and an injection was performed (96372), then no matter what, (given there is appropriate documentation), a -25 would be appended to the 96372.
    No... mod-25 is never appended to a procedure code, only to E/M codes.
    Walker Bachman, CPC, CPPM

  7. #17
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    Again, I know I "said" 96372, but I meant -25 is appended to the E/M BECAUSE of the 96372.

    Nevermind.
    Heidi Thompson, CPC

  8. #18
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    Quote Originally Posted by hthompson View Post
    I think I am understanding now (after reading and a lunch break ) that it's not the procedure that needs to be significant, it needs to be the E/M that is significant enough to warrant a code which then needs a -25.
    Now you got it! The mod-25 is telling the payer that you are billing for an E/M visit that is in addition to the one that is already included in the 96372. If you do not put the mod-25 on it, they will bundle the E/M encounter with the injection and you will not get paid separately for it.
    Walker Bachman, CPC, CPPM

  9. #19
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    Quote Originally Posted by hthompson View Post
    Again, I know I "said" 96372, but I meant -25 is appended to the E/M BECAUSE of the 96372.

    Nevermind.
    I'm sorry.. I can only go by what is typed, and you typed that you would append the -25 to 96372. I apologize for misunderstanding..
    Walker Bachman, CPC, CPPM

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