# Cpt/Modifier question



## BRETT (Aug 26, 2008)

I recently billed a 99212 (physician visit) and a 90772 (injection given by the nurse) on the same date of service.  The 90772 paid, however, the 99212 denied stating it was inclusive to the 90772.  When I spoke with the insurance, I was told I could rebill with a modifier and this would possibly pay.  Which modifier would you suggest? and what cpt would you apply it too?  Thanks for all suggestions!


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## dmaec (Aug 26, 2008)

you'd need a .25 modifier on the office visit - IF,  you actually do have a "significant, separately identifiable Evaluation and Management Service provided by the same physician on the same day of the procedure or other service" (in your case the injection)... that being said;
we typically do not charge out the 90772 on commercial insurances when there is an E/M also, (as it's inclusive of the visit).  For Medicare and medicare like (MA/PMAPS), we append the modifier .25 to the office visit when we bill out the 90772.  And if it's an injection only, like a B12 injection - we code out only the 90772 & J3420 -  no office visit with it.
_{that's my opinion on the posted matter}_


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## zaidaaquino (Aug 26, 2008)

CPT 90772 includes 99212.  You can unbundle it by using modifier -25 on the E&M if in fact it is a significant, separately identifiable E&M serivce.  (Are you also using a J-code?)

Zaida, CPC
Urology office


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## BRETT (Aug 26, 2008)

Thank You!


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