tci Part B Insider - 2010 Issue 29

Reader Questions: Check Rules for Injection + E/M

Question: A payer denied our claim for an established patient office visit in addition to 96372. We appended modifier 25 and appealed but were denied again. What are we doing wrong?Answer: If you're billing a payer that follows the Correct Coding Initiative (CCI), the edits bundle office visit codes 99212- 99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) into therapeutic injection code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).Good news: If your documentation supports the office visit as significant and separately identifiable from...

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