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Pre-Planned Orthovisc injection

  1. #1
    Seattle First Hill
    Default Pre-Planned Orthovisc injection
    Medical Coding Books
    We are having a debate in our clinic about this. A patient is seen and the doctor tells them to follow up next week for their first Orthovisc injection. The doctor's believe that at that follow-up visit, they can charge for an E/M as well as the injection. My concern is where is the medical necessity to justify the E/M? My understanding was that if an injection is pre-planned and that is the only reason the patient is coming back in, then an E/M is not billable. The doctors seem to think they can get around this by stating "patient returns for further discussion and after discussing the options, have decided to go forth with their first injection".

    Any input would be GREATLY appreciated!!
    Last edited by kjstearns; 10-13-2009 at 12:25 PM.

  2. #2
    Greeley, Colorado
    If the appointment is scheduled as an injection, then that is all they should be charging. Inflating the documentation to try and get reimbursement for an E/M is simply bad business...most would even view it as fraud. I certainly do. Once the decision to proceed with the injection is made and the patient then schedules for the injection on a different date, there is no billable E/M. Keep in mind that all procedures do have pre procedure values to them based on the RVU system, which would be the E/M for that service unless there is a significant separately identifiable E/M service provided on the same date.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Seattle First Hill
    Thanks Lisa! I completely agree with you!!

  4. #4
    North Carolina
    Me toooooooooo

  5. #5
    Me 3rd!

  6. #6
    trying to "get around it" is going to get them in TROUBLE!!!
    Mary, CPC, CANPC, COSC

  7. #7
    Seattle First Hill
    I agree, Mary. I have showed them documentation and their response is, "Well, that's your interpretation." So frustrating!!

  8. Default Pre-planned Orthovisc
    Hi KJ...I share your frustration! I managed an Orthopaedic Surgical practice for 15 years and not one of those years had a single day of smooth sailing. The doc expected to bill an E&M EVERY SINGLE VISIT and to boot, he wanted ALL E&M's to be 99215! I practically stood on my head making him understand that if the record did not reflect both medical necessity and proper and complete documentation, no E&M could be billed. If the patient is scheduled for this injection - that's all they are entitled to bill for.

    Again, I share your frustration and the thought occurred to me that perhaps you work for the doc I moved 1,200 miles away

    Have a great day and never compromise your values!

  9. #9
    Seattle First Hill

    Thank you so much for bringing a smile to my face. I think that maybe I do work for the same doctor you did! Glad to know that I am not the only one out there that is having this problem too!

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