Repeat Injections, Can I bill an E/M?

by  Codapedia
July 29th, 2016

When reporting an office visit in conjunction with an injections/arthrocentesis we need to consider a few factors. First we need to be certain we are accurately applying modifier -25 which is required when a procedure is performed the same day as a procedure. In order to report modifier -25, the service should be significant and separately identifiable; above and beyond the usual preoperative and postoperative care associated with the procedure. In 2002, OIG conducted an audit randomly selecting 450 claims and it was discovered that thirty-five percent of claims using modifier 25 did not meet the program requirements resulting in $538 million in improper payments . 
Report an E/M on the same day as a procedure when:
·         Documentation supports a significant and separately identifiable E/M services was provided on the same day as the procedure.
·         E/M is medically necessary and supported via documentation; with the appropriate key components i.e. history, exam, and medical decision making.
Do not report an E/M on the same day as a procedure when:
·         Documentation does not support the E/M service.
·         Services are not medically necessary.
Reminders:
§ Be very careful when reporting an E/M with a procedure when it is a repeat or planned procedure. Typically, services of this nature do not meet the requirement to append modifier -25 in that the service is not significant or separately identifiable; over and above what is typical pre and post procedure work.
§ A separate diagnosis is NOT necessary when reporting an E/M with a procedure on the same day.
§ Avoid routinely reporting an E/M; just because a patient enters the office, an office visit may not necessarily be reportable or medically necessary.
§ Be mindful of existing global period you may need to append both modifiers -24 & -25 to the E/M service along with modifier -79 on the procedure.
§ Modifier-25 has been targeted by the Office of Inspector General for over-utilization under a special fraud alert.
Sources:
http://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf
http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-25.shtml
http://www.palmettogba.com/palmetto/webtool.nsf/vtool/mod25

References:

Repeat Injections, Can I bill an E/M?. (2016, July 29). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/repeat-injections-can-i-bill-an-e-m-28173.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.