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E/m & 90772

  1. #1
    Post E/m & 90772
    Medical Coding Books
    When can you bill an E/M with modifier 25 when doing an injection of drug with 90772?


    Pt goes to medexpress for poison ivy, the Dr. sees the pts and decides to give a shot of cortisone. Would you bill the E/M J-code and 90772 with mod 25 on the E/M?

  2. #2
    Central Dallas
    yes, the E/M would have the modifier 25 appended and then bill the J code and the 90772 admin code.

  3. #3
    Duluth, Minnesota
    No, the adminstration of the drug is included in the E/M - so just the E/M and Jcode (unless you're coding Medicare, then you can code the 90772 and add the .25 to the E/M Part A side)
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  4. #4
    Per Medicare guidelines, physicians are instructed not to bill 99211 "on the same day as a drug administration code that has a work relateive value unit."
    Payment for any E/M service the nurse routinely provides in the course of adminstering an injection is included in the appropriate injection code such as 90772.

    Medicare does allow higher-level office visits to be billed on the same day as a drug administration service with -25 as long as the medical necessity is apparent.

    Ex: 90772, 99211
    Ex: 99212-25, 90772, J-code (documenation must support a higher-level ov)

    Hope this helps.

    Zaida, CPC

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