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To Bill or NOT bill an E/M

  1. #1
    Everett, WA
    Default To Bill or NOT bill an E/M
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    Our specialty practice has a patient with a commercial insurance who comes in regularly (sometimes twice a week) for treatments of acute persistent headaches, which usually consist of injections and/or infusions depending on dr.'s assessment. The charges are always posted with an E/M and although there is the initial physicial evaluation I'm wondering if continuing to charge these E/M services is really acceptable. One of our valued list members had cautioned us about this and I understand if the patient comes in to get the injections specifically, then the E/M most likely would NOT be billable, but these acute situations are occuring quite regularly along with exacerbating issues. WHAT specificially triggers that we should stop billing the E/M visits?---Suzanne E. Byrum, CPC

  2. #2
    I would say if he has to physically examine the patient to determine the proper treatment (injection vs infusion) then an e/m would be acceptable. Of course if treatment has already been determined before the pt gets to the office then I would say that an e/m would not be billable. Just my opinion. Hope this helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    If the patient is scheduled as an injection or infusion on the office schedule, then you can not charge the EM visit, unless the patient has a new problem. Does the physician give the injection or infusion? If so then you can charge the 99211 if at least 3 vitals are done on the visit. This would be the only time you would charge a 99211 for the physician. You will find some insurances will not pay for the 99211 for an injection. Therefore, you would charge the injection fee code for those insurances. Hope this helps.

    Jill Gibson-Ratliff, CPC

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