Wiki E/M billable with injection

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cohela

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Hi, need help with being able to bill a continous problem (alopecia) visit. Dr is billing only injection code 11900 and J3301 (Kenalog) without E/M. Dr states since it is a continous problem and patient gets injections only that we cannot bill for an E/M because it isn't a new problem.

can someone help me witht his, b/c I have worked previously family medicine and if you are still addressing the issue, I feel that an E/M of level 2 can be billed along with the injection because physician is talking/treating the dx.
 
Your doc is right. You would bill an E/M along with the injection if the provider is evaluating the problem and making the decision how to treat it. Since this has already been done and the patient is just coming in for the injections, you cannot bill for anything other than the injections.
 
ok, thanks catch the wind. one more question, now, if the Dr. has to address the alopecia again (consider a different form a treatment) along w/ giving the injection will they then be able to charge an E/M?
 
If the treatment plan was established at another visit by this treating physician, scheduled procedures would not indicate medical necessity to support a separate E&M. Only the procedure and drug are reportable unless there is a completely separate problem addressed at the same encounter.

Medicare states in the NCCI Coding Manual, "the decision to perform the minor procedure is included with the fee of the minor procedure". The E&M must be significant or for a separate problem.
 
Cohela: the answer to your new question is "yes."

OCD_coder: Medicare's statement that "the decision to perform the minor procedure is included with the fee of the minor procedure" does not apply to IM injections. It only applies to procedure with a 0, 10, or 90 day global period. The global concept does not apply to IM injections. (Note that "does not apply" is not the same as 0 days!)

In a thread on this topic in the E/M forum, Cynthia Hughes provided the following information: "The global period concept does not apply to IM/subcut. injections so you cannot look at this as you do procedures that are assigned a 0 or 10 day global (ie, have pre-service physician work). The only physician work included in an injection is confirmation of the order for the injection and supervision of the staff who perform it. If you can find the CMS articles from around 2004 when this physician work was assigned to the injection and chemotherapy services, I think you will find that CMS indicates that modifier 25 is required to prevent reporting of an E/M service for supervision of these services when no other physician E/M is provided on that date. This is not the same as the use of modifier 25 with a procedure that includes pre-service physician work."
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The original post is for CPT code 11900, which has a 0 global period. I believe this information I presented applies. I would agree with the information that preop work is not part of a 96372 IM injections, which is what is being a little misleading in the previous post.

If a separate E&M service beyond the procedure is documented, then a modifier 25 can be supported and is not for pre-procedural work then of course we would want to support the E&M. More often than not as I audit, there isn't enough information to support both procedures. It's all in the documentation, of which we do not have access to.
 
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Ok, so when Dr sees the patient to do 11900 & J3301 (Kenalog) but had to re-evalute the patient,discuss possible new treatment) along with documentation supporting a PHI,PFSH would the physician be able to charge for a level 99211 or 99212? I read the Health Busniess article and it states that you could if documentation supports
 
My understanding is that you cannot, because 11900 is a regular "minor surgery" procedure that includes all that in the code.

There was a great article in the AAD journal online that said, in short: "One should subtract the entire E/M component included in a given procedure?s valuation and then see what amount of E/M service is left. If nothing is left, then a separate E/M billing is inappropriate." Here is a link to the entire article: http://www.aad.org/dw/monthly/2013/july/to-25-or-not-part-two
 
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