Wiki E/M, modifier 25, injection

[tkscpc]

Scenerio: Established patient previously diagnosed with OA returns to the office with knee pain. My doctor gives an injection. Can I charge an E/M using modifier 25 with the primary diagnosis as knee pain or do I omit the E/M and attach OA to the injection? And would the decision make a difference if it's been 3 months or a year since the patient was last seen?

 

[Manasa Reddy Salipela]

Established patient hence both E/M and injection CPT with modifier 25 can be given.

As patient is established (seen with in last 3years) and he has OA KNEE so based on the E/M elements history, PE and MDM 99211 to 99215 can be given along with 20610 or 20611 based on the documentation with a modifier 25 to E/M and the ICD should be OA knee as pain is the symptom of OA.

 

[thomas7331]

Normally a visit with a modifier 25 on the same day as a minor procedure is only supported if there is 'separately identifiable' E/M beyond the normal pre- and post-operative E/M associated with the procedure. CMS does considers the decision to perform the procedure to be part of a minor procedure and not sufficient in an of itself to warrant an E/M code. If the provider is evaluating or managing something other than what is addressed in the procedure, such as requesting diagnostic tests or setting up physical therapy or home care, this could constitute separately identifiable E/M even though the diagnosis is the same. You'd really need to look at the specifics of the documentation to make this determination.

 

[bedforak1]

I agree. It would depend on the documentation. If the patient was scheduled to come in for the injection, I wouldn't suggest billing an E/M.