# Diagnosis codes - symptoms vs. condition



## mrolf (Oct 12, 2011)

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.


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## missy874 (Oct 12, 2011)

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.


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## mitchellde (Oct 12, 2011)

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.


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## kvangoor (Oct 12, 2011)

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.


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## missy874 (Oct 12, 2011)

I believe a modifier 25 is fine in this circumstance.  Never had a problem before.


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