Wiki New Patient Visit with Joint Injection

[Maureen Pulcini]

If an Orthopedic Surgeon sees a new patient and decides to give a joint injection for a Medicare patient after the PCP has exhausted all other pain medications can you bill a NP E&M code with a 25 modifier? I was just told that those rules changed in 2013 and that can no longer be done for a MC patient. Can you please reply to my work email address :
Maureen_Pulcini@chs.net

 

[nyyankees]

If an Orthopedic Surgeon sees a new patient and decides to give a joint injection for a Medicare patient after the PCP has exhausted all other pain medications can you bill a NP E&M code with a 25 modifier? I was just told that those rules changed in 2013 and that can no longer be done for a MC patient. Can you please reply to my work email address :
Maureen_Pulcini@chs.net

yes you can. It's a bit confusing but if the note supports an E/M you can bill. As usual it will always come down to the documentation in the note.

 

[RebeccaCross*]

Below is Medicare's guidance on this subject. If the documentation can support the E/M based on the guidelines below, it could be reportable.

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.

http://www.cms.gov/Medicare/Coding/...ect=/NationalCorrectCodInitEd/NCCIEP/list.asp

Once you open the link, you can find this information at the bottom of the page. Click on the link titled "NCCI Policy Manual for Medicare Services". Open "Chapter 1" PDF. You'll find the information beginning on page 19.