Wiki E&M with cortisone injection

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debatortho

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We are an ortho office and have been very careful about billing an office call with an injection for an established patient. If it is a new problem, we will bill the office call of course, but we have a number of patient's that just come in routinely for injection and we don't bill and E&M for those. My question is - when a patient comes back after an MRI scan which is reviewed with the patient and the decision is made to do a cortisone injection - can I bill an office call? Thanks!
 
debatortho said:
We are an ortho office and have been very careful about billing an office call with an injection for an established patient. If it is a new problem, we will bill the office call of course, but we have a number of patient's that just come in routinely for injection and we don't bill and E&M for those. My question is - when a patient comes back after an MRI scan which is reviewed with the patient and the decision is made to do a cortisone injection - can I bill an office call? Thanks!
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As long as you've got the components documented, you should be able to bill an E/M - the key is, that there was a medical decision made at the encounter. You still have to have a chief complaint, at least one HPI, and a physical exam documented, in addition to the MDM to be able to bill it. Medical necessity is definitely there, though, so you're safe.

You guys are correct in not billing an E/M when the patient's injections are part of a previously established regimen, but you can bill for patients who had already had their problem established, as long as there was a significant change to their treatment plan - trying out an iinjection (even just once), is enough to count as a significant change.;)
 
Perfect. I will see if I can get them to do an exam in that instance and then we can bill. Thanks!
 
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