Wiki Injection Code and Office Visit

[nsclark2]

When a patient comes in and is dx as 473.9 OR 478.0 and the patient is also given a Depo injection. We bill for the office visit, but can we also bill for the 96372 or 30200 that we have to report with the J1040? Or do we just bill for the office visit and the drug and the injection cost is in the office visit?
This is confusing to me.

 

[Lisa Bledsoe]

You should be able to bill for the administration and the medication. Depending on the insurance, you may need modifier -25 on your E/M.

 

[nsclark2]

Even though there is just the one diagnosis?

 

[Lisa Bledsoe]

Hmmm. Good point. I guess it depends on if it is known ahead of time that the injection will be performed. 30200 has a higher RVU value than say 99213, so that might be the preferred way to go.

 

[mitchellde]

If you look at appendix A in the CPT book under modifier 25 it says... "as such separate diagnosis are not necessary for application of the 25 modifier. You do NOT need more than one diagnosis when you append a 25 to the office visit. You only need the documentation to support the use of the modifier.