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Diagnosis codes - symptoms vs. condition

  1. Default Diagnosis codes - symptoms vs. condition
    Medical Coding Books
    My question is this – When billing an e/m 99213 with a modifier 25 and then an administration of IM injection 96372 along with the drug J code charge. I have a biller/coder telling me that you are to assign the symptoms of the Acute Bronchitis to the E/M (i.e. Cough) and then assign the code Acute Bronchitis to the Injection Administration 96372 and the J Code. What is the opinion of other fellow coders? I thought you would never assign symptoms that are related to the condition. I have read many Q&A by CMS that states you don't need different diagnosis codes to bill an e/m with a modifier 25. I believe this is being done to make sure payment occurs. Do other clinics receive payment by assigning the same code to the e/m and drug adm code? Any thoughts or suggestions would be appreciated.

  2. #2
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    If the provider definitively diagnosed acute bronchitis in the visit, you code it as acute bronchitis. I have never had a problem with same diagnosis with a mod 25. As a result of his office visit he diagnosed bronchitis and then decided to treat with the injection. This happens quite frequently.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
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    The coding guidelines specify that you do not code the symptoms once a definitive dx is documented. And in Appendix A of the CPT book it states a separate dx is not required for correct application of the 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Grand Rapids, MI
    Posts
    230
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    There is a CCI edit for billing an e/m visit along with the 96372. I don't think that would be payable on the same DOS.

  5. #5
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    I believe a modifier 25 is fine in this circumstance. Never had a problem before.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

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