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EM charge with office-based injection code?

jonnylingo

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May 7, 2006
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  1. Attending Physician
    A patient requests to see you again. He had relief 6 months ago with trigger point injections and wants them repeated.

    You see him, do brief history, focused eval, and repeat injections. You also discuss what meds he's taking and discuss stretches. Face to face time is 15 min.

    Do you bill an EM code 99213 in addition to trigger point inj code (20552)? I've heard at a billing conference that some "chat time" is build INTO procedure codes.
     

    pmrmd

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    1. Attending Physician
      A patient requests to see you again. He had relief 6 months ago with trigger point injections and wants them repeated.

      You see him, do brief history, focused eval, and repeat injections. You also discuss what meds he's taking and discuss stretches. Face to face time is 15 min.

      Do you bill an EM code 99213 in addition to trigger point inj code (20552)? I've heard at a billing conference that some "chat time" is build INTO procedure codes.

      Absolutely bill the OV. If exercises are discussed and demonstrated, you may also include 97110.
       
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      Ducttape

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      1. Attending Physician
        Bill it with modifier 26. I personally do my own billing now.

        so are you saying that the modifier 26 allows you to bill for your discussion, but the actual exercise itself is the technical component?

        Modifier 26 Fact Sheet
        Definition

        * Professional Component refers to certain procedures that are a combination of a physician component and a technical component. Using modifier 26 identifies the physician's component.

        Appropriate Usage

        * To bill for only the professional component portion of a test
        * To report the physician's interpretation of a test
        * Procedures that have a "1" in the PC/TC field on the MPFSDB
        * Procedures falling into the following types of service;
        1-Medical Care/Injections
        2-Surgery
        4-Radiology, 5-Lab, 6-Radiation Therapy and 8-Assistant Surgeon

        (i assume you do not mean modifier 25 to bill for the 99213 and 20552...)
         

        pmrmd

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        1. Attending Physician
          do you get paid for billing 97110? a decent amount?

          thats a new one. never really thought about it, but with some patients, i guess i could use this code. anyone else use it?

          Sure we get paid, not a ton, but I won't turn down a few extra bucks. Been doing it for years. I document that the exercise was provided AND demonstrated and the patient performed it though. Not just discussion.
           
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          specepic

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          1. Attending Physician
            There have been several prior discussions regarding mod 25, but I think it is a subject worth discussing. I almost always use a -25 mod in clinic when I see a pt and do an injection. I only time I do not is when:

            -synvisc series when we already made decision to do inj prior such as inj #2 and #3, however often the pt will want to address other issues so then e and m may occur
            -botox for migraine if, again, I saw them recently and we decided to book an appt for 2 weeks and inj then
            -all my OR/spine inj's are booked ahead and we do inj only, if the pts asks a bunch of questions or for an rx we will address and bill e and m, but that is uncommon


            I think most of us here are not block jocks and spend time counseling and dealing with out pts complexities, we should be justified being compensated for that
             
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