tci E/M Coding Alert - 2014 Issue 5

Reader Question: No Modifier When E/M is Months Prior to Injection

Question: If a doctor injects a high-end injectable such as Synvisc, Hyalgan, Orthovisc or Euflexxa, is it alright to charge an E/M with modifier 25? Our practice is that we do not bill an E/M with a high-end injectable if the physician discussed the injections with a patient up to as long as three months prior to the injection. West Virginia Subscriber Answer: You cannot bill an E/M service, with or without modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or...

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