Wiki Pain Procedures & E/M

[beverlybellamy]

If patient presents with the intention to receive a pain management procedure (ESI) but patient has had a change in condition and physician opts to change treatment plan (could be an adjustment in the medication administered/injected or the location of the injection), would it this meet criteria for "separate and identifiable" as defined by modifier 25?

Thanks in advance!

Bev

 

[Nirosha Boyapati]

Yes, we can consider this service as "separate and identifiable", because there is a change in patient condition and also physician changing the treatment plan.
So, we can code E/M service with 25 modifier along with pain management.

 

[beverlybellamy]

That is what I thought too Nirosha, but someone argued with me saying it couldn't be for same condition (although worsened/changed). I think while it might be denied for payment initially, an appeal with a copy of the record to show the change would validate payment. Thanks for responding!

Anyone else have an opinion to share? Would love to know how others handle this...