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Billing for material

  1. #1
    Location
    Monmouth County
    Posts
    66
    Default Billing for material
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    Good morning and Happy Halloween

    Can someone please confirm, I can bill for a trigger point injection and the material injected with an OV

    99204-25
    20552
    J3301

    Thanks!

  2. #2
    Default
    20552 & J3301 can be billed.

    Whether 99204-25 can be billed will depend if its significant and separately identifiable.
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  3. #3
    Location
    Monmouth County
    Posts
    66
    Default
    what about this, but the injection was planned

    99213
    20553

    Thanks

  4. #4
    Location
    lawrence, kansas
    Posts
    54
    Default
    Without the -25, E/M code will bundle into the injection and will not be paid separately. We routinely perform these injection in office as well. If a full exam was truly done, then there should be no harm in using the modifier -25. Reginald, I am wondering why you would change the office visit code from 99204 to an established 99213? Either the patient is new or established. If the medical decision making was made at a prior office visit and the patient was only returning for the injection, I would err on the side of caution with billing out a whole new exam.
    Ryan Raich, CPC COSC
    Lawrence, Kansas Chapter President

  5. #5
    Location
    Monmouth County
    Posts
    66
    Default
    Hi,
    I didn't switch the E/M code. These are just examples. Some new patients are scheduled for a TPI on the next visit, so my question is, if the patient is scheduled for the injection, and the patient really wasnt seen for any other reason, can an OV be billed. My opinion, the Dr should not bill for an OV with a planned procedure unless the patient has something totally new going on. Am I correct in saying this?

  6. #6
    Default
    Quote Originally Posted by REGINALD068 View Post
    Hi,
    I didn't switch the E/M code. These are just examples. Some new patients are scheduled for a TPI on the next visit, so my question is, if the patient is scheduled for the injection, and the patient really wasnt seen for any other reason, can an OV be billed. My opinion, the Dr should not bill for an OV with a planned procedure unless the patient has something totally new going on. Am I correct in saying this?
    Scheduled injection should not have an E&M as all minor procedures include an E&M component. It would need to be significant and separately identifiable whether new or established patient.

    From the NCCI manual

    If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.

    Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.
    Last edited by CodingKing; 11-02-2018 at 12:35 PM. Reason: fixed quote
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  7. #7
    Location
    Monmouth County
    Posts
    66
    Default
    Thanks for the confirmation

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