Wiki EM vs. Injection/Cast

[kadensmom]

One of my colleagues believes it is okay to omit billing an injection or cast application and bill the office visit instead. She says she wants to do this because the reimbursement is higher for the office visit when compared to the injection or cast application. My initial thought is that this is not a good idea - it appears to be dancing around bundling edits to obtain higher reimbursement. My second thought is that we are to code to the highest specificity...the office visit code does not tell the story of all services rendered when an injection is performed or a cast is applied. Am I over thinking this? If the office visit is related to the procedure performed, I feel like the office visit bundles and the procedure should be billed regardless of reimbursement.

Any guidance, documentation, or literature in support of either opinion is appreciated.

 

[Orthocoderpgu]

E/M vs injection or casting

Your college should remember this:

"According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure. See "Application of Casts and Strapping" in the CPT book in the Surgery Section, under the Musculoskeletal system."

Go with your gut feeling on this. Follow correct coding guidelines. Remember, you WILL get audited at some point. Anything that is incorrectly billed in an effort to get more RVU's your office will get fined for. It may take a while, but with electronic medical records we are being audited much more than we were before. It's too easy for an insurance company to ask for medical records. They can be sent on a thumb drive.

I even had an insurance company deny a 99214 stating that they did not feel the medical records would support the code. I looked to see if medical records were ever sent to the insurance company and they had not been sent. So I pulled the E/M records and sure enough the documentation did not support a 99214.

Follow the coding guidelines and you will not have to worry about audits.