AAPC - Back to school
Results 1 to 3 of 3

Thread: To Bill or NOT bill an E/M

  1. #1
    Join Date
    Apr 2007
    Everett, WA

    Default To Bill or NOT bill an E/M

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    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
    Join Date
    Apr 2007


    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

Similar Threads

  1. employee flu shot - to bill or not to bill
    By arrana in forum Compliance General Discussion
    Replies: 0
    Last Post: 10-11-2013, 12:31 PM
  2. To bill a Pyloroplasty or not to bill.....
    By HILLIC in forum General Surgery
    Replies: 1
    Last Post: 07-15-2013, 11:20 AM
  3. 95971/95972 To Bill Or Not To Bill???
    By AndieL in forum Anesthesia
    Replies: 1
    Last Post: 04-18-2012, 09:20 PM
  4. Bill or not to bill that's the question!!??
    By Love Coding! in forum E/M
    Replies: 3
    Last Post: 03-13-2012, 05:11 PM
  5. how to bill or not bill for volunteer doctor
    By aces78rp in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-29-2007, 07:18 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.