Wiki Diagnosis codes - symptoms vs. condition

[mrolf]

My question is this – When billing an e/m 99213 with a modifier 25 and then an administration of IM injection 96372 along with the drug J code charge. I have a biller/coder telling me that you are to assign the symptoms of the Acute Bronchitis to the E/M (i.e. Cough) and then assign the code Acute Bronchitis to the Injection Administration 96372 and the J Code. What is the opinion of other fellow coders? I thought you would never assign symptoms that are related to the condition. I have read many Q&A by CMS that states you don't need different diagnosis codes to bill an e/m with a modifier 25. I believe this is being done to make sure payment occurs. Do other clinics receive payment by assigning the same code to the e/m and drug adm code? Any thoughts or suggestions would be appreciated.

 

[missy874]

If the provider definitively diagnosed acute bronchitis in the visit, you code it as acute bronchitis. I have never had a problem with same diagnosis with a mod 25. As a result of his office visit he diagnosed bronchitis and then decided to treat with the injection. This happens quite frequently.

 

[mitchellde]

The coding guidelines specify that you do not code the symptoms once a definitive dx is documented. And in Appendix A of the CPT book it states a separate dx is not required for correct application of the 25 modifier.

 

[kvangoor]

There is a CCI edit for billing an e/m visit along with the 96372. I don't think that would be payable on the same DOS.

 

[missy874]

I believe a modifier 25 is fine in this circumstance. Never had a problem before.