Wiki E/M Service and Joint Injection

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swiessner

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Hello,
I am having a ton of trouble billing an E/M service and Joint Injection together when they are separately identifiable. We are a family practice and our PA does joint injections. We had a patient come in for her regular 6-month recheck, and our provider discussed her normal medical issues, acid reflux, etc. The patient then brought up bilateral hand pain so the provider did a bilateral joint injection. Am I still stuck only billing the joint injection? The insurance is BCBS Help!
 
swiessner said:
Hello,
I am having a ton of trouble billing an E/M service and Joint Injection together when they are separately identifiable. We are a family practice and our PA does joint injections. We had a patient come in for her regular 6-month recheck, and our provider discussed her normal medical issues, acid reflux, etc. The patient then brought up bilateral hand pain so the provider did a bilateral joint injection. Am I still stuck only billing the joint injection? The insurance is BCBS Help!
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Hi, my understanding is the joint injection includes evaluation and management unless a separately identifiable evaluation and management service is identified. Meaning, was there any action taken to address any other issues? You stated they discussed her normal medical issues, acid reflux, etc. but if there was nothing done to address those issues then the E/M is included in the joint injection.
 
My understanding: the patient was there for another reason (manage chronic conditions) and brought up a new complaint. After taking a history related to the hand pain and doing an examination, the provider made the decision to do the joint injection.

You should be able to bill for a separate E/M service. If they had decided to manage the hand pain with RICE or OTC meds, you would have still billed for the visit, with the problems addressed being hand pain, acid reflux, etc. But I would make sure my documentation was very clear that this was a new complaint and the decision for the injection was made during the course of the visit.
 
I think we can bill E/M service separately with modifier 25 but the medical necessity reason must be documented in the visit note. As the patient came for a routine 6-month recheck and the injection was not planned earlier by the physician on the day of the encounter patient brought a new complaint of bilateral hand pain during the visit after the evaluation physician planned to perform an injection as this service may support medical necessity criteria only thing is the physician must document all information visit note and add a note the injection was planned today after the evaluation and not planned earlier,

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