Urology Coding Alert

Question: I thought Medicare would pay for E/M services as well as G0356 when we report them together. Medicare, however, is denying our office visits and is paying only for the injection code. Am I incorrect in my thinking?


Nevada Subscriber

Answer: You can report G0356 (Hormonal anti-neoplastic) with E/M services. To code correctly and to receive payment, you need to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other services) to the E/M service code.
 
Code G0356 is a temporary G code that Medicare introduced in 2005 to replace 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia). Although you will very likely see less reimbursement from the G code than you did from the CPT codes, you can still report it with E/M services and receive full payment on both codes. By adding modifier 25, you're ensuring that the carrier realizes the E/M service was separate from the drug administration.

For example, a patient comes to your office for a Lupron injection but also complains of dysuria and urinary frequency. Your physician examines the patient and ordersa urinalysis, which reveals an acute urinary tract infection (599.0, Urinary tract infection, site not specified). You should submit 99214-25 (Office or other outpatient visit for the evaluation and management of an established patient ...) for the exam, and G0356 for the injection.