Same Day Injection

[knoxdoc]

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I can't remember the last time I did a same-day injection. I have a medicare patient who I saw for a new eval this am and she was scheduled with me this afternoon for a R SIJ injection. How does MC generally handle this - are they going to cut the pay substantially for the injection? Is it a 25 modifier that I use for the injection? Thx.

 

[Ducttape]

yes with regards to less pay.

technically, you arent supposed to bill a visit and an injection on the same day if it is the same diagnosis.

its not a 25 modifier unless your new patient eval was to ostensibly discuss some other issue - such as spondylosis lumbar spine, long term use other medications (ie gabapentin or NSAID).

 

[knoxdoc]

Thanks Duct. The patient is willing to pay out of pocket for the procedure, so that will likely be how I handle it because no other significant diagnosis/issue was discussed.

 

[Ducttape]

did you discuss medication management for chronic back pain of >3 month duration?

did you discuss treatment (such as PT) for spondylosis lumbar spine?



might be more amenable than out of pocket payment...

 

[pmrmd]

Medicare patient? There has to be another diagnosis there somewhere. Use that for the E&M code.

 

[Baron S]

I'll say that every time I do a same-day procedure, I feel like get screwed over somehow.

 

[nvrsumr]

If paying out of pocket just have them sign an abn for procedure

 

[PM&ARGHH]

Can someone enlighten me about same-day injections? I’m a recent grad at a mixed specialty practice with established pain docs, the culture is to do same-day injections. I would say 50-75% of my procedures are referrals for eval+injections from a partner or 99214+injection on my own patients. I’ve been told by billing department we get paid on enough of these that it’s worth doing, but I’ve also caught some errors so am trying to learn for myself.

 

[knoxdoc]

I ended up talking to our billing guru (large state-wide ortho clinic). She said I could put the -25 modifier on the E&M visit and bill the SIJ without a modifier, even in the case of the same diagnosis being used for both, and I would get paid in full for both. That's what I ended up doing. She said it will work for medicare (Palmetto), but not for all insurers. I'll try to remember to review the collections later and see if she was right.

 

[Welcome123]

I ended up talking to our billing guru (large state-wide ortho clinic). She said I could put the -25 modifier on the E&M visit and bill the SIJ without a modifier, even in the case of the same diagnosis being used for both, and I would get paid in full for both. That's what I ended up doing. She said it will work for medicare (Palmetto), but not for all insurers. I'll try to remember to review the collections later and see if she was right.

They can do a clawback later even if you get paid.
If you want to get reimbursed for an office visit, you need to have another body region to bill.

 

[22yis]

They can do a clawback later even if you get paid.
If you want to get reimbursed for an office visit, you need to have another body region to bill.

If you do a full level 4 visit (order procedure). Then get the prior authorization for the procedure and book it with e/m 25 modifier after it’s approved why would they claw it back?

 

[Welcome123]

If you do a full level 4 visit (order procedure). Then get the prior authorization for the procedure and book it with e/m 25 modifier after it’s approved why would they claw it back?

Ncci edits if it same day-if it is a separate visit the office visit should be reimbursed

 

[Ducttape]

they can claw back anything they deem indicated, if something does not fall in their "guidelines". for example, if there is no documentation of failed 4 weeks of conservative therapy prior to injection.

in specific, i agree, it seems they are unlikely to claw back if you have done an initial eval then get PA then do procedure. on separate date.

Ncci edits if it same day-if it is a separate visit the office visit should be reimbursed

not sure the point you are making?

first, you have to add a modifier.

An indicator of "1," however, means that you may use a modifier to override the edit if the procedures are distinct from one another. For example, the edit bundling breast biopsy with imaging guidance (19102) to biopsy without guidance (19100) includes a "1" modifier indicator. This means that if the biopsy with guidance occurs at a different location than the biopsy without guidance (for instance, one service occurs on the left breast and the other on the right breast), you may report the services independently.

the procedures are distinct from one another. i would take this to mean a visit for sacroiliac dysfunction is not different from a visit for an injection for sacroiliac dysfunction.

a visit for spondylosis lumbar spine is different from an injection for sacroiliac dysfunction.

 

[Welcome123]

they can claw back anything they deem indicated, if something does not fall in their "guidelines". for example, if there is no documentation of failed 4 weeks of conservative therapy prior to injection.

in specific, i agree, it seems they are unlikely to claw back if you have done an initial eval then get PA then do procedure. on separate date.


not sure the point you are making?-as reimbursement pertains to same day injection -the office visit will either be denied if no other body region is addressed. A few years back ( maybe 5) ago the NCCI edits consider eval and injection on the same day as inclusive.

first, you have to add a modifier.


the procedures are distinct from one another. i would take this to mean a visit for sacroiliac dysfunction is not different from a visit for an injection for sacroiliac dysfunction.

a visit for spondylosis lumbar spine is different from an injection for sacroiliac dysfunction.