Wiki E/M Code and Injection Administration Code

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mishortho@sbcglobal.net

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Does anyone have any luck getting an E/M code and Injection administration code paid for same DOS? We are an orthopedics office in Indiana, so we do a lot of injections. Here recently almost all of them are getting denied. Typically we are billing out a 99213 , 20610, and J3301. The 20610 and J3301 are being paid for but not the actually office visit. Is there a modifier that would allow us to still get paid for both? Or do we need to have the patients come back for a seperate visit for the injection? Any guidance or advice is appreciated.
 
mishortho@sbcglobal.net said:
Does anyone have any luck getting an E/M code and Injection administration code paid for same DOS? We are an orthopedics office in Indiana, so we do a lot of injections. Here recently almost all of them are getting denied. Typically we are billing out a 99213 , 20610, and J3301. The 20610 and J3301 are being paid for but not the actually office visit. Is there a modifier that would allow us to still get paid for both? Or do we need to have the patients come back for a seperate visit for the injection? Any guidance or advice is appreciated.
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Hello, there are great discussions already posted on this.

The best advice I've seen on this is this:

When you do any procedure, there is a certain amount of E/M associated with it--as little just making sure the patient still wants to go through with it to a full pre-op physical - all part of the "global" and inclusive. Having said that, to determine if you can bill for that E/M visit with a 25 modifier, take a pencil and cross off everything that the doctor would have done if the patient had just come in for the injection alone - that is, had actually just scheduled just the injection (because we all know those visits, barring additional problems, are not billable E/Ms) - whatever is left: x-rays, labs, other complaints, other plans, medication orders, other management options, et cetera - that's the portion that is actually billable as a separately identifiable E/M.

I just saw that today and loved it. Hope it helps you, I'm going to utilize it.
 
mishortho@sbcglobal.net said:
Does anyone have any luck getting an E/M code and Injection administration code paid for same DOS? We are an orthopedics office in Indiana, so we do a lot of injections. Here recently almost all of them are getting denied. Typically we are billing out a 99213 , 20610, and J3301. The 20610 and J3301 are being paid for but not the actually office visit. Is there a modifier that would allow us to still get paid for both? Or do we need to have the patients come back for a seperate visit for the injection? Any guidance or advice is appreciated.
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Hello,

I work for a payer. We typically deny the E/M code when it is billed with a minor surgical procedure (ie, 20610). Reason being, per CPT guidelines the surgical procedure billed as 20610 includes evaluation and management service. However, if the submitted documentation addresses another issue outside the injection and the correct modifier is billed, then we will allow the E/M. Many times, it all comes down to supporting documentation. I hope this helps :)
 
We have this issue with our local Highmark Blue Cross but with 96372/B12 injections.. most time the patient is being seen for a follow up on multiple chronic conditions and are also due for their B12 injection.. the insurance will almost always automatically deny the office visit as CO97 if ICD-10 E53. 8 is the primary DX used for the 992xx and 96372 even if we are using modifier 25.. i have had some luck with reordering the diagnosis codes making E53.8 the primary on only the 96372 and J3420 only and another chronic condition the primary for the E&M. IF that doesn't work though i have to dispute and submit the chart notes for reconsideration to support the billing of both.

If there are no other conditions that are being managed though i will still submit the records and allow the payer to determine if it meets their guidelines for separate reimbursement if that doesn't work we have to write it off..
 
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