Wiki E/M w/ inject

[PLAIDMAN]

I am feeling some pressure to bill 99213 with 20610. I have read the ncci manual and it states

"the decision to perform minor surgical procedure is included in the payment for the minor proced and should not be reported separately as an E/M service"

my boss says a "new problem" w/ decision for inject can be billed. Keep in mind my entire E/M is related to the injection.

I don't know how a "new prob" on an established pt trumps ncci edits as well as does not meet the definition of 25 mod.

Can anyone tell me what I am missing ? Are you billing established E/M with an injection (20610)?

thanks for any help.

 

[amyjph]

You are not missing anything, I agree with you and insurance companies are enforcing this rule now and denying the E&M even if it has a 25 and even if it is a new patient. You could try to bill it & appeal if denied if the patient was seen for a separate issue. For example if they came in for OA of the knee & had an injection but also had enough documentation to justify a separate E&M for another problem like CTS or something unrelated.