Wiki New Patient E/M with injection 20610

[JDuhaime]

We are finding that new patient office visits billed with injections are being denied as not medical necessary. The injection is being paid . An office visit is performed and Patient is new.

99203,25 was billed with 20610 and the J code


Should the 99203 be down coded to 99202 when an injection is billed?

 

[Melissa Harris CPC]

No, If the new patient visit documentation supports a level 3 you should bill a level 3. You never downcode because an injection is performed the same day.

 

[JDuhaime]

No, If the new patient visit documentation supports a level 3 you should bill a level 3. You never downcode because an injection is performed the same day.

Thank you- It looks like the documentation did not support the level 3

 

[Pam Warren]

20610 is a minor procedure. As such, the E&M is automatically bundled in. The -25 modifier can bypass the edit, but some payers ignore the modifier and won't pay it anyway, even if it's separately identifiable. The denial for medical necessity has nothing to do with the level of the E&M. What they're saying is that the E&M (that they didn't pay) with the minor procedure is not medically necessary and they'll only pay fo the injection/aspiration.

 

[SharonCollachi]

Another reason we don't evaluate a patient and do procedures same day. How could you possibly do a major joint injection on a new patient without a thorough workup first?