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E/M with injection

  1. Question E/M with injection
    Medical Coding Books
    If a patient come in with dx of bronchitis and is given a Kenalog injection. Can the following codes be filed with Medicare and other carriers? 99212w/ 25modifier 96372 and J3301. I am just not sure and dont want to do anything wrong.



  2. #2
    Greeley, Colorado
    My question for you is why is it a 99212 for bronchitis? Is the documentation that poor?
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Yes that is how our office would bill the services, however I do agree with Lisa that is a low E/M for bronchitis.

  4. #4
    Default E/M with injections
    Would you still bill it this way even if the DX is the same for all the procedure codes?

    Gina, CPC, CEMC

  5. #5
    Quote Originally Posted by gmlittle View Post
    Would you still bill it this way even if the DX is the same for all the procedure codes?

    Gina, CPC, CEMC
    Walker Bachman, CPC, CPPM

  6. #6
    Does everyone bill a mod -25 for a 99212, 96372, J3301?
    Heidi Thompson, CPC

  7. #7
    Quote Originally Posted by hthompson View Post
    Does everyone bill a mod -25 for a 99212, 96372, J3301?
    Well, only if the documentation supports it.

    If the patient had an office visit the previous week and is returning for the injection, then no, you wouldn't bill an office visit.

    If the patient came in because of knee pain, the MD did a full workup, and decided to give the injection while the patient was in the office, then that would qualify for a separately billable E/M service, assuming the documentation was there.

    It's a situational thing.
    Walker Bachman, CPC, CPPM

  8. #8
    I just never envisioned a 96372 as a -25 appropriate code. I'd stick it on 20610 in a heartbeat, given the situation that it supported it, but it never once entered my mind that 96372 qualified.
    Heidi Thompson, CPC

  9. #9
    I think it's because all the coding classes I've attended, put some weight on the description.

    -25 Significant, Separately Identifiable Evaluation and Management Service by the
    Same Physician on the Day of a Procedure

    I don't see anything "significant" about a therapeutic injection. It's a poke in the arm, etc. Separate yes, but not significant.

    I do see it as significant for a TPI or joint injxn, because that takes more skill and a dr does it.

    Help me see what you're seeing
    Heidi Thompson, CPC

  10. #10
    Now I'm confused. You would never use a mod-25 on anything except an E/M code. Why would you use it on a 20610?
    Walker Bachman, CPC, CPPM

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