Wiki Beyond the usual preop work injection

[gaultsm]

We have been trying for a while to figure out the use of the 25 modifier on the E/M code when an injection is given at the same time. Does any one know what is considered the usual preoperative work of an injection (ie. knee inj). I am not sure whether we can bill the E/M if we don't know what the usual is.
If the doctor does a work up including history, exam of the knee, and decision making (needs an injection) is that enough or is that the usual?

 

[nyyankees]

We have been trying for a while to figure out the use of the 25 modifier on the E/M code when an injection is given at the same time. Does any one know what is considered the usual preoperative work of an injection (ie. knee inj). I am not sure whether we can bill the E/M if we don't know what the usual is.
If the doctor does a work up including history, exam of the knee, and decision making (needs an injection) is that enough or is that the usual?

Wish I had that info but the way I look at it is:

1. Did patient know of the injection coming in = No E/M
2. Doc did work-up and at end of work-up decided patient needed injection = Yes E/M
3. Patient knew of injection + new problem (i.e. shoulder pain) = Yes E/M

Hope this helps..