Wiki Preventative visit with an E/M service

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tanyaword0207

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A patient had a preventative visit but at the same time complained about her neck hurting. The provider did extra workup on the patient and gave her an injection to alleviate the neck pain.

I billed the preventative visit, 99396(without the M 25) and then the E/M 99212 with M 25 (as we were taught at AAPC), and added the admin and injection fee, J1885 and 96372.

CPT 99396 was denied against 96372 - I know there is an NCCI edit on these too but the M25 on the O/V should be all needed or are we supposed to put the M25 on both??

I would really appreciate any feedback.

ANYBODY?
 
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Prev visit with an E/M service

This may be carier driven. The injection administration is what the insurances like to include in the office visit. So they may not reimburse for the injection admin. I would look at the policy requirements for the service. You could potentially use modifier 59 on the admin code but again check CCI Tables and payer guidance first. Make sure diagnoses are applied appropriately to each E/M.
 
I agree; in cases like this I usually bill the admin for the injection with modifier -59. I rarely have trouble with reimbursement when it's billed this way.

Hope that's helpful!
 
BCBSTX denied the Preventative E/M - I looked at the O/V as an entirely separate visit and as such I wouldn't add the M59 on the injection fee because the E/M has M25, but it makes sense because it covers both E/M NCCI edits that way.

Thank you all for your feedback!
 
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