Ob-Gyn Coding Alert

Question: How do I code a claim when a patient comes in for a blood test and/or injection? How can we appeal if it is denied due to being a part of the office visit?

Nebraska Subscriber

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Answer: Many payers believe evaluation and management (E/M) codes include what they term incidental procedures that do not require significant physician time or work to accomplish. This may include things like an injection or collection of a blood sample for testing. However, CPT states specifically that these services can be reported separately because the purpose of the E/M code is to report only E/M services, not other procedures or services identified by another code (see page 2 of CPT 2001, professional edition).

Unless the payer has specifically excluded an injection or blood draw from being reimbursed at the same time as an E/M service as part of their policy manual, you may code either one in addition. You may, however, have to add 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 service to indicate that it was separate from the other services provided that day.

If the only reason for the visit was the blood draw or injection and no E/M service was provided or documented, code for the blood draw or injection.