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injection admin

  1. #1
    Default injection admin
    Exam Training Packages
    If a patient comes in for a rash and the documentation equals a 99213 and the patient is given a injection, should we also charge a 96372 for the injection. Do we need to add a 25 modifier to the e/m code?

  2. #2
    Location
    Columbia, MO
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    12,561
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    yes you also use a 96372 assuming it was IM or SQ and yes you need a 25 modifier on the OV. You do not need a separate dx code for this.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    thank you

  4. #4
    Default Tda, ba, cpc
    My experience is that if the office visit was only focused on the rash, and therefore, the reason for the visit, then the administration would be bundled into the E&M for that visit. I have found no insurances that will cover a situation like this with E&M for the one problem focused issue, then adding an administration; they will discount the administration.

  5. #5
    Location
    Columbia, MO
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    12,561
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    Quote Originally Posted by tdaustin View Post
    My experience is that if the office visit was only focused on the rash, and therefore, the reason for the visit, then the administration would be bundled into the E&M for that visit. I have found no insurances that will cover a situation like this with E&M for the one problem focused issue, then adding an administration; they will discount the administration.
    You dono need a separate dx code, i you look in appendix A of the CPT book you will see that it says this. When the payer discounts your payment or bundles this they are basing this on trends. And the trend has proved that the documentation rarely supports payment for both. As long as you have met the parameters for the use of the 25 modifier you need to appeal this type of reimbursement.

    Debra A. Mitchell, MSPH, CPC-H

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