E/M with procedure

[gaschicago]

Following scenario: A referral to perform an injection (ESI/TFESI/SIJ etc). from surgeon or external provider was created and the injection was approved/verification of benefits was completed. Patient comes to your office on a separate day for the procedure, can you bill E/M code with modifier 25 on day of procedure along with the procedure code?

You are a different speciality (pain/anesthesia) from the surgeon or other referring provider.

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[vadim1980]

I usually bill an E/M code and 25 modifier if I’m either evaluating the patient for another issue during the injection visit or if I’m re-evaluating the patient to change or amend the procedure requested. Would like to hear the other input though

 

[Welcome123]

I usually bill an E/M code and 25 modifier if I’m either evaluating the patient for another issue during the injection visit or if I’m re-evaluating the patient to change or amend the procedure requested. Would like to hear the other input though

This may no longer apply due to recent ncci edits if u use the same icd codes for procedure and office visit
If there is another problem (axial and radicular pain, that you can break ii into different body region or complaints, such as weakness, sensory loss, back/hip/leg, gait dysfunction you should be able to get the office visit paid on appeal if it denied

 

[Ducttape]

no, i dont think it was ever valid... if the purpose was to do the injection, i dont think you can use the 25 modifier.

you could bill for the E/M by discussing what meds they are taking and tweak them. for example, stop ibuprofen not helping/ change to naproxen/ consider taking omeprazole for GI protection etc. then add cpt for "long term monitoring nonsteroidal antinflammatory". or change neuromodulator dose and add cpt for "long term monitoring other medication."