annyoungiic
New
Does this scenario represent a significant and separately identifiable E&B service?
Patient presents to the doctor with complaints of shoulder pain. Doctor performs H&P, ROS, and exam and assessment. Doctor makes the decision to perform an injection of ketorolac and orphenadrine. Doctor bills 99213-25 with 96372. 99213-25 is denying as being included in the injection services.
In review of the AMA Coding with Modifiers 6th edition, page 46 and Chapter XI Evaluation and Management Services page XI-31, Medicare NCCI Policy Manual lead me to believe it is.
CPT 96372 has a global period of XXX and does not follow the same global period guidelines as procedures with 000, 010, or 090. AMA Coding with Modifiers 6th edition, page 50 says "With most XXX procedures, the physician may, however, perform a significant and separately identifiable E/M service on the same DOS, which may be reported by appending modifier 25 to the E/M code. This E/M service may be related to the same diagnosis necessitating performance of the XXX procedure..."
Can you clarify this for me? Is there any other reference material on this subject?
I greatly appreciate your input.
Patient presents to the doctor with complaints of shoulder pain. Doctor performs H&P, ROS, and exam and assessment. Doctor makes the decision to perform an injection of ketorolac and orphenadrine. Doctor bills 99213-25 with 96372. 99213-25 is denying as being included in the injection services.
In review of the AMA Coding with Modifiers 6th edition, page 46 and Chapter XI Evaluation and Management Services page XI-31, Medicare NCCI Policy Manual lead me to believe it is.
CPT 96372 has a global period of XXX and does not follow the same global period guidelines as procedures with 000, 010, or 090. AMA Coding with Modifiers 6th edition, page 50 says "With most XXX procedures, the physician may, however, perform a significant and separately identifiable E/M service on the same DOS, which may be reported by appending modifier 25 to the E/M code. This E/M service may be related to the same diagnosis necessitating performance of the XXX procedure..."
Can you clarify this for me? Is there any other reference material on this subject?
I greatly appreciate your input.
Last edited:
