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E&M and 25 modifier with injection into joint

  1. #1
    Question E&M and 25 modifier with injection into joint
    Medical Coding Books
    Help me clarify how you distinguish significant, separately identifiable service. I have a new patient who comes in with pain and stiffness in a joint. The Dr reviews symptoms, does the PFSH, an exam, xrays and then discusses options with the patient. The decision to give the injection was made by the patient. Can we bill the E&M and 20610? Previous chats indicated that even if the patient is new, an E&M is built into the 20610 or any minor procedure for that matter.

  2. #2
    Default reference
    http://www.aaos.org/news/aaosnow/oct09/managing1.asp

    here is a reference that provides an example similar to your situation

  3. Default
    Quote Originally Posted by lynnsherwood View Post
    Help me clarify how you distinguish significant, separately identifiable service. I have a new patient who comes in with pain and stiffness in a joint. The Dr reviews symptoms, does the PFSH, an exam, xrays and then discusses options with the patient. The decision to give the injection was made by the patient. Can we bill the E&M and 20610? Previous chats indicated that even if the patient is new, an E&M is built into the 20610 or any minor procedure for that matter.
    Ummm you just stated that the patient is new... did a ros, pfsh, exam, xrays and then discussed the options. FOR SURE YOU CAN CODE AN E/M!!!!!!! If the patient came in for just the injection and it was scheduled that way, then no you couldn't bill an e/m unless it was significant and separtely indentifiable.

  4. Default
    Quote Originally Posted by eadun2000 View Post
    Ummm you just stated that the patient is new... did a ros, pfsh, exam, xrays and then discussed the options. FOR SURE YOU CAN CODE AN E/M!!!!!!! If the patient came in for just the injection and it was scheduled that way, then no you couldn't bill an e/m unless it was significant and separtely indentifiable.
    Yes, I completely agree.
    E=evaluation=collecting the history, assessing patient through an exam.
    M=management=decision to perform a procedure.

    If the decision to perform a procedure was done at a previous visit then no e/m is billed.
    Dee
    CPC, CPCO, CPMA, CPCD

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