Wiki cortisone injection and E/M

[desertsteph65]

I have been researching the rules for charging an e/m visit and a cortisone injection. Most of our patients come in for evaluation and then he decides to do a cortisone injection. I have found a lot of conflicting information. I have been applying a modifier 25 to the e/m and have been paid for that but every once in awhile we get denied. Is there an answer to this ongoing problem.??? I know that on synvisc the first office visit is OK but after that you cannot charge for an e/m.

 

[nyyankees]

I have been researching the rules for charging an e/m visit and a cortisone injection. Most of our patients come in for evaluation and then he decides to do a cortisone injection. I have found a lot of conflicting information. I have been applying a modifier 25 to the e/m and have been paid for that but every once in awhile we get denied. Is there an answer to this ongoing problem.??? I know that on synvisc the first office visit is OK but after that you cannot charge for an e/m.

If they knew of the injection coming in don't bill an E/M unless there is an unrelated issue addressed. If, during the course of the exam the doc decides an injection is warranted I would bill E/M with 25 mod. It's a tough one as I've had carriers deny E/M's that should be paid.

 

[desertsteph65]

thank you for your help.