Anesthesia Coding Alert

Reader Question:

Billing E/M and an Injection Can Be OK

Question: Can I code an E/M visit along with an injection? The anesthesiologist discussed the possibility of performing pain management injections during a standard visit, and the patient agreed to have one that day. Should I include any modifiers with the claim?

Tennessee Subscriber Answer: Yes, you can code for both an E/M visit and an injection administration on the same day, but report the procedure as a Type of Service "01" (medical care) instead of Type of Service "07" (anesthesia service). Be sure to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to document that performing the injection during the standard visit was unusual but necessary.
 
Some carriers initially balk at reimbursing claims with modifier -25. If the carrier denies the claim, resubmit it with the physician's notes for review. Also remember that you can only bill an E/M visit with an injection if the E/M resulted in the decision to perform the injection or if the patient has an "Oh, by the way" type of problem the physician learns about during the visit. If the patient comes to the physician for the injection, the E/M visit is bundled with the procedure and cannot be separately coded.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Anesthesia Coding Alert

View All