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Ob-Gyn Coding Alert

READER QUESTION:

Evaluate E/M and Injection Visits

Published on Mon Jan 01, 2007

Question: How should I bill for a focused follow-up visit for a patient on Depo-Provera and also for administering the injection during that visit?


Pennsylvania Subscriber


Answer: If she presents for an evaluation of the problem for which she is receiving the Depo-Provera, you can bill for that E/M service (such as 99213, Office or other outpatient visit for the E/M of an established patient -).

You will not receive reimbursement for the injection in addition, however, unless the E/M is separate and significant from the injection procedure. Many payers are now interpreting this to mean that the E/M must be at least a level three before they will consider paying for both, and of course, you would need to append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M service.  
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