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help settle discussion

  1. #1
    Default help settle discussion
    Exam Training Packages
    Can someone please direct me in the right direction to locate the guidelines that state: if you charge a OV, Injection, and adminstration code that the adminstration DX needs to be different from the OV and injection?

  2. #2
    Columbia, MO
    you do not need a different diagnosis only the documentation to support the assessment of the patient is over, above, and beyond what is necessary for the procedure. If the injection was preplaned then the assessment to determine the necessity of the injection has already been performed and cannot be charged for again, therefore for a planned injection, to charge an ov you would need a different diagnosis. However if it were not prior planned and an assessment did occure which goes beyond the nesessity for the injection then you could stll charge for both the ov and the administration (using a 25 modifier) and the smae diagnosis code linked to both. Look in appendix A of the CPT book under the definition for the 25 modifier it tells you in this definition the different diagnosis are required.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thanks for your help...but maybe I should give this example

    CC: Cough
    injection given
    Should adminstration be charged?


    CC: chronic conditions F/U HTN DM
    during exam patient complains of cough - injection is given
    should the adminstration be charged?

    Thanks again for all the help

  4. Default admin fee
    In the first case of cough injection given you would charge the admin code and the j code for the drug but no OV code w mod 25 because no SIGNIFICANT separately ide3ntifiable E&M was done.

    In the second case, matters other than for which the pt got the injection for were done so you would bill an OV w mod 25, admin code, and j code for the drug.

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