# Need help with office visits and joint injections



## dboutwell (Mar 28, 2012)

I am having denials with office visits 99213 and joint injections 20610. I spoke to someone at Medicare and they said the 20610 was considered a minor surgery and was included in the office visit.  I had been billing 99213 with a 25 modifier.  I would appreciate any help.


----------



## ewinnacott (Mar 28, 2012)

The -25 mod is used only if the patient comes in with another problem other than what they're originally coming in for. So if they came in for just the injection then you would bill the 20610 only BUT if they came in for the injection and was also being treated for a cold for example then you would bill the 99213-25 and the 20610. Another possibility is that the patient comes in for the office visit with joint issues and the doctor decides to do the joint injection then you can also bill the 99213-25 and the 20610.


----------



## jmcpolin (Mar 28, 2012)

I code for an osteo group and the patients come in regularly for injections and the doctor might dictate an office visit at that time but we never bill the E&M because we know the patient is coming in for the injection.


----------



## dboutwell (Mar 28, 2012)

Thank you both for your input.  It is very helpful.  On most of the patients I will probably just bill the injection.


----------



## butterflyed (Apr 25, 2012)

We are receiving denials for the patients that come in with joint pain and then receive a injection at the same visit. Our MAC said the office visit is inclusive of the injection, but this is the first time the doc has evaluated and decided injections are needed. Anybody have any ideas on how to fight this one with Medicare?
Thanks!


----------



## butterflyed (Apr 25, 2012)

We are receiving denials for the patients that come in with joint pain and then receive a injection at the same visit. Our MAC said the office visit is inclusive of the injection, but this is the first time the doc has evaluated and decided injections are needed. Anybody have any ideas on how to fight this one with Medicare?
Thanks!


----------



## armen (Apr 25, 2012)

butterflyed said:


> We are receiving denials for the patients that come in with joint pain and then receive a injection at the same visit. Our MAC said the office visit is inclusive of the injection, but this is the first time the doc has evaluated and decided injections are needed. Anybody have any ideas on how to fight this one with Medicare?
> Thanks!



If there was an E/M that is not just a pre-op for injection then you should append modifier 25 to your E/M. It will be paid.


----------



## MMadrigal (Apr 25, 2012)

butterflyed said:


> We are receiving denials for the patients that come in with joint pain and then receive a injection at the same visit. Our MAC said the office visit is inclusive of the injection, but this is the first time the doc has evaluated and decided injections are needed. Anybody have any ideas on how to fight this one with Medicare?
> Thanks!



We run into this problem when we have a consult or initial E&M, but have seen the patient for something else in the past 3 years, we are forced to code the recheck E&M with mod -25, the injection code 20610 and the Rx code.  We always drop to a hardcopy claim and attach the clinical note to support the 9921_ mod -25.  Print in box 19 "CLINICAL NOTE ATTACHED TO SUPPORT 9921_ -25".  As long as it is the first time you are seeing the patient for the body part injected, both get paid.  If you have seen the pt in the past 3 years for this same body part, you can only bill the injection and Rx. Mary


----------



## armen (Apr 27, 2012)

I'm really surprised to see you guys are having problems with E/M even when 25 is attached.


----------



## ppt (Apr 27, 2012)

what icd 9 code do you have when you bill for both codes + modifier 25?  Im very surprise that medicare denied it.


----------



## butterflyed (May 3, 2012)

We just received a call from our local MAC- Noridian. They had placed edits in their system to deny all E&M's on the same day as a injection. They re-evaluated this based on a number of us physician offices calling and fighting for payment. So I think we should be both on the same page for billing the initial E&M and office visit together using the 25 modifier.


----------



## campy1961 (May 3, 2012)

We have never had medicare deny our claims for E/M and 20610.  Now we have two different dx codes: 1 for the E/m and 1 for 20610.  

If it is the same dx we hav been putting mod 59 on 20610 if the dx is the same since that is the only reason they came in to get relief.  

We have been getting denials from UHC on only the injections.


----------

