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Subsequent Injections

  1. Question Subsequent Injections
    Medical Coding Books
    This is a multi-leveled question and if anyone has any documentation to support me either way that would be great.
    We are getting alot of denials for an E/M with an injection. As far as I am aware if we bill a -25 modifier on our E/M the E/M and is payable. This is for first time injections or drugs such as depo-medrol. Correct?
    However, where does this stand for susequent injections (IE Euflexxa, Hylgan)? We have been billing a level 2 as its straight forward decision making, problem focused exam and history and full set of vitals are taken. Is that correct?

  2. #2
    Everett, WA
    I hope others will comment to this, and the first thing you might want to do is to searchthru the archives on here by doing a general search. Our practice also has issues with EM visits coded with J codes and the administration injection code of 96372. Various payers will pay and others will deny the administration as bundling or incidental OR deny the EM visit, but that's happening less frequently. Usually, I follow up with an appeal and a good portion of the time, the denials are overtured, but it is a tedious process. Right now trying to get the doctor to supply/improve better documentation, but it's been a battle. You may find the answer you seek in the archives. Normally if criteria fits we'll bill out:
    96372-59 etc, etc

    Just a start for you....

    Suzanne E. Byrum CPC Everett, WA

  3. #3
    Default subsequent injections
    We rarely bill an e/m for subsequent Supartz injections (series of 5) with the injection code 20610 (large joint). In order to bill an e/m, documentation should clearly establish that the e/m involved work over and above that typically associated with the procedure done at the same encounter and thet teh encounter's sole purpose was not to perform the procedure. I hope that helps.

  4. Default
    If the injection was scheduled in advance (these subsequent injections typically are), there should be no additional E&M charge. The medical decision making was prior to the first injection. If, however there was a problem being addressed separate from the problem requiring the injection, you could possibly charge for an E&M, providing your documentation supported it.


  5. #5
    Columbia, MO
    Exactly, if you have a planned subsequent injection then the assessment for the necessity of the injection was already performed. The assessment needed to provide the injection is already an inclusive part of the injection administration and it may not be charged again. That is why the 25 modifier is worded the way it is.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    I also agree with previous posts. There is no medical necessity for E/M service if injections were scheduled for advanced, unless there is something new requiring an evaluation. We do a lot of Suartz inj and I usually bill one first visit with E/M

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