Wiki 20610 Billed W/E&M Code

[ieshiarenee]

Hello,
My provider and I have been going back and forth on this issue.

If a patient comes in for knee pain, has a full exam and later had the knee injected with kenalog, are we able to bill the E&M code along with drug code and the injection code 20610, or is the injection code included in the E&M?

Thanks for your help.

 

[sxcoder1]

You can charge for the injection and drug codes with a 25 modifier on the E/M.

 

[CodingKing]

depending on the carrier they may bundle the drug code into the injection code

 

[KMCFADYEN]

Be very careful with your modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) usage.
To bill both the E&M and the injection, your documentation must be able to stand alone.

 

[hamlinr2005]

If it's an established patient with an established problem, we just do the injection. If it's a new problem and needs the exam to determine the injection is necessary or if it has been an extended time since the patient has been in and requires a re-evaluation, we will use the modifier 25 on the EM.

 

[ieshiarenee]

Thank you everyone for your responses!