Wiki E/M with Drug Supplies, 25 mod?

[mebjones83]

I've searched high and low for this answer, but have been unable to get a definitive answer:
Does an office visit code need modifier 25 attached when billed with a drug alone (HCPS code)?
Example:
A patient has an office visit (99214) and receives a Kenalog injection (J3301) for allergic rhinitis. Insurance bundles 96372 (injection), so I don't report that. Do I report 99214 with a 25 modifier along with J3301? Or simply report 99214 and J3301 without a modifier? Thank you.

 

[sls314]

I've searched high and low for this answer, but have been unable to get a definitive answer:
Does an office visit code need modifier 25 attached when billed with a drug alone (HCPS code)?
Example:
A patient has an office visit (99214) and receives a Kenalog injection (J3301) for allergic rhinitis. Insurance bundles 96372 (injection), so I don't report that. Do I report 99214 with a 25 modifier along with J3301? Or simply report 99214 and J3301 without a modifier? Thank you.

NCCI edits are where you'd look to see if codes bundle and would need a modifier (when appropriate) to bill.

That being said, you need to report the injection code when billing the drug.

Is there a distinct and separately identifiable office visit, or is the patient just coming in for the injection?

 

[mebjones83]

NCCI edits are where you'd look to see if codes bundle and would need a modifier (when appropriate) to bill.

That being said, you need to report the injection code when billing the drug.

Is there a distinct and separately identifiable office visit, or is the patient just coming in for the injection?

According to NCCI edits it's ok without the modifier (99214 and J3301). When billed with 96372 (therapeutic injection) it is repeatedly denied by insurance for bundling, (even with 25 mod. on the office visit code), so I have stopped billing 96372.