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Injections

  1. #1
    Cool Injections
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    I am trying to understand when to code the injection on an office visit. Here are a few examples.
    1) new patient comes in with knee pain and the doc's diagnosis is DJD. Recommends an injection and it is decided to proceed with the said injection to the knee. Would you code the office visit and the injection with modifier 25 or would you just code the injection without the office visit.
    2) same as above but with an est. patient.
    3) What if a est patient comes in with an sore ankle, but while in with the doc the patient tells him he also has shoulder pain. The doctor decides to inject the shoulder and use conservative methods for the ankle. would you code an office visit w/ the injection with a modifier 25?

    Thanks, I don't know why I can't get a handle on this situation.
    Rich

  2. Default get a handle on injections
    Hi Rich,

    I don't know if you have already figured out the coding
    The doctor saw the pt. and arrived at diagnoses on the same encounter, he ordered an injection correct?-you code for office visit first code E/M cpt code new or established pt. Then cpt code for injection depending on what kind of injection and append modifier 51 to show to insurance payor that more than one procedure was done on that pt. encounter.
    Modifier 25 is significant,seperate and indentifiable E/M, same physician/ same day.
    Giving an injection is not considered E/M and the injection would not be a seperate, significant E/M same physician/same day. It would be part of the same pt encounter. you would then code the appropriate diagnoses or ICD-9 to warrant the injection.

    Hope this helps,
    K

  3. #3
    Default injections
    Quote Originally Posted by richking503 View Post
    I am trying to understand when to code the injection on an office visit. Here are a few examples.
    1) new patient comes in with knee pain and the doc's diagnosis is DJD. Recommends an injection and it is decided to proceed with the said injection to the knee. Would you code the office visit and the injection with modifier 25 or would you just code the injection without the office visit.
    2) same as above but with an est. patient.
    3) What if a est patient comes in with an sore ankle, but while in with the doc the patient tells him he also has shoulder pain. The doctor decides to inject the shoulder and use conservative methods for the ankle. would you code an office visit w/ the injection with a modifier 25?

    Thanks, I don't know why I can't get a handle on this situation.
    Rich
    1.) I would code E/M-25 with injection admin and med injected
    2.) I would code same as 1 except with est E/M code.
    3.) I would code same as 1 and 2 plus whatever conservative treatment done to the ankle (if any).

    The key to these is to have a separate and identifiable E/M from your procedure. If the patient was scheduled for an injection, then there would be no E/M, that would be bundled into the injection. But in all 3 of these scenarios they made the determination at the time of the visit to do the injection due to extreme pain/discomfort to the patient.
    Some carriers do not require a 25 modifier with injection codes, however, I haven't ran across those yet.
    Any other opinions out there?
    Good luck!

  4. #4
    Location
    Everett, WA
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    Default
    I see we're already getting differences of opinions, and I've been struggling with this as well, Rich, so you're not alone. I'd like to run with this thread and insert a case of my own. WHAT if the patient were an established patient with the DJD, who comes in fairly regularly for injections (although NOT scheduled) asking for acute care in the office setting? This could happen two or three times a month. The fact that that patient asked for acute care treatment (knowing most likely he'll get injections?) will preclude the likelihood that this could be an EM billable visit? Yes or no? I also know the components must be there to determine the level, but am questioning even if they are, if the EM would be acceptable to bill. Really hoping for more lively input on the topic of injections!
    ---Suzanne

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Decision for procedure vs scheduled procedure
    If the patient is scheduled to come in for the injection - NO E/M.

    If the patient comes in with a complaint, is evaluated and the decision is made to give an injection, code the E/M with -25 modifier and the injection (or whatever other procedure, like I&D, or lesion removal).

    The key to these is when is the decision to perform the procedure / give the injection made?

    Suzanne ... if your doctor notes something on the lines of ... "return next week for another treatment if pain persists" then I would NOT code the E/M on that folloing visit, but just the injection. On the other hand, if there is no specific indication of a "plan" for another injection, then you are fine coding the E/M that results in a decision for the treatment.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
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    I totally agree with FTessaBartels! 100%
    Heidi Thompson, CPC

  7. #7
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    I also code the way F Tessa says.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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