# Therapeutic injections during an e/m



## Melissa_M (Apr 29, 2012)

We have always billed a -59 on the 96372 when performed during an e/m (other than 99211). Example: 99213, -25=401.1, 480.9
96372, -59=480.9
J3301 x4 units=480.9

We are now part of a large group of providers and are being told that we can not bill as above.  We receive payment for the 96372.  What are your thoughts?

Thanks,

Melissa


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## mitchellde (Apr 29, 2012)

you do not need a 59 on the 96372 only a 25 on the E&M.  If only an injection is performed then only the 96372 is billed, never a 99211 instead of or with the 96372.


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## ringalls (Apr 29, 2012)

Debra Mitchell is correct you will not need a modifier -59 on the 96372, although id you are charging a 96374 with a 96372 you will need a modifier on the IM injection
Robin Ingalls-Fitzgerald, CCS, CPC, FCS, CEMC, CEDC
Medical Reimbursement Specialists


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## ollielooya (Apr 29, 2012)

clarification, please...
So IF the EM is billable and if a 96372 AND 96374 are performed, a modifier WOULD need to be attached to the 96372 as in:  99213-25, 96374, 96372-59.  Is this correct?  Suzanne E. Byrum, CPC


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## armen (Apr 30, 2012)

ollielooya said:


> clarification, please...
> So IF the EM is billable and if a 96372 AND 96374 are performed, a modifier WOULD need to be attached to the 96372 as in:  99213-25, 96374, 96372-59.  Is this correct?  Suzanne E. Byrum, CPC



What they are saying is that you do not need to attach 59 to any code billed with and E/M if it is the only code billled in addition to an E/M, only 25 for E/M to unbundle an E/M. You need to attach 59 to 96372 since there is a CCI edit bundling it with 96374.

And you need to bill an E/M only if there really was an E/M and not just a regular pre-op which is part of any surg proc. The use of modif 25 woudl not be justified then.

So E/M-25 + 96372   or E/M-25 + 96372-59 + 96374


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## Melissa_M (Apr 30, 2012)

Thanks everyone! The answers have been very helpful.

Melissa


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