I am trying to clarify appropriate coding for injections that a provider may perform on new patients. I work in a hybrid Urgent Care/Primary Care setting that has a PA specializing in Orthopedics. Often times, a new patient (Urgent Care) will come in with say joint pain and the PA will perform a full evaluation prior to determining treatment, which may or may not include injection.
As an example, he will see a patient for knee pain. He takes a history, examines them, takes xrays. After doing all of this, he determine that they have osteoarthritis of the knee. He will discuss all of the treatment options with them, which can include, activity modification, prescription NSAIDs, joint injection, and surgical referral. Many patients can opt for any of these, and any of them can be viable treatment options.
In this example, he performs a full workup, and then following discussion makes the decision to perform a knee injection CPT code 20610. The injection was not planned at presentation, and also not necessarily a distinct part of the visit, ie we chose to perform the injection today on top of the new patient evaluation.
It seems appropriate that I would code this patient as a 99203 with a 25 modifier and the 20610 CPT code. This is in contrast to if he had been seeing the patient for a few visits, and had previously discussed cortisone with them, and they came in and he would inject them. In that case, I would just code the 20610. I have been getting audit feedback that I should not code the E/M with a 25, that only the 20610 should be coded since the E/M is not a distinct service. I am in the NGS jurisdiction and do not know if this coming into play with the ruling. Can you please weight in with correct coding for this scenario. Thank you!
As an example, he will see a patient for knee pain. He takes a history, examines them, takes xrays. After doing all of this, he determine that they have osteoarthritis of the knee. He will discuss all of the treatment options with them, which can include, activity modification, prescription NSAIDs, joint injection, and surgical referral. Many patients can opt for any of these, and any of them can be viable treatment options.
In this example, he performs a full workup, and then following discussion makes the decision to perform a knee injection CPT code 20610. The injection was not planned at presentation, and also not necessarily a distinct part of the visit, ie we chose to perform the injection today on top of the new patient evaluation.
It seems appropriate that I would code this patient as a 99203 with a 25 modifier and the 20610 CPT code. This is in contrast to if he had been seeing the patient for a few visits, and had previously discussed cortisone with them, and they came in and he would inject them. In that case, I would just code the 20610. I have been getting audit feedback that I should not code the E/M with a 25, that only the 20610 should be coded since the E/M is not a distinct service. I am in the NGS jurisdiction and do not know if this coming into play with the ruling. Can you please weight in with correct coding for this scenario. Thank you!