Reader Question: E/M and Injection

Question: Can I charge Medicare for an E/M service and 90782 during the same session? For example, if a patient with a history of chronic allergic rhinitis sees the physician but also reports acute allergy symptoms, can I bill an E/M visit with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) as well as 90782 and J1040?

California Reader

Answer: You can never bill Medicare for 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular; 0.12 RVUs) and an E/M service during the same visit because the E/M code includes the work involved in administering the drug. The value of 90782 is so minimal (0.12 RVUs) that if anything else is performed at the same time, the injection is usually included in the other service and, therefore, should be billed only when performed on its own.

Medicare has stated that the professional charge for administration of the injection should be included in the E/M code. The small amount of work for preparing the shot included in 90782 is lost as soon as an E/M service is performed.

In this case, the examination and the injection both relate to the patients allergy symptoms. Even if the patient had two unrelated diagnoses, 90782 should not be billed.

Therefore, the scenario described should be coded:

9921x established patient office or other
outpatient visit; and

J1040 injection, methylprednisolone acetate, 80 mg.


- Published on 2001-06-01