Wiki Preventative Exam on Same day as E/M AND injection

[k.keller]

We have several patients who have come in for their annual preventative exam. While here (as always) they are also seen for some other medical issue and are charged with a separately identifiable E/M code and a -25 modifier is added to this line item. The patient also receives a vaccination or injection by our nursing staff and the administration code 90401 or the injection code 96372 is also added. Because both the E/M code and the preventative medicine code are to be bundled into the vax injection or IM injection code, I've added a -59 modifier to this code. The carriers are all bundling the preventative exam in with the injection code. What am I missing? The injection code is in the column 1 for the NCCI edits, so perhaps a -59 modifier should go on the preventative exam code but this is not a procedure, which is what this modifier is for so I am just stuck!! I've contemplated adding a second -25 modifier to the preventative exam code but I've never seen this before - claim with (2) -25 modifiers? This started occurring with the 10/1/12 HCPCS update. Is anyone else experiencing this? How do I fix it?! Help!

Krystin Keller

 

[maddismom]

I would add modifier 25 to the preventative code. I've seen this before and it looks odd, but it should compliantly get you paid.

 

[k.keller]

I would add modifier 25 to the preventative code. I've seen this before and it looks odd, but it should compliantly get you paid.

Thank you!! I will try it all at this point but I want my appeal to be strong so I didn't want to just wing it! Thanks for letting me know that you have at least seen this before!

 

[OhioMB]

I also have added the 25 modifier to the preventative visit. It will pay. As long as you have documentation to support your visit charges there should be no worry. I would evalutate whether or not your separate E&M is truly justifiable.