An Office Visit and an Injection. Can I Bill Both with a Modifier 25?

December 15, 2016

Question:
A colleague informed me that billing an office visit every time I give a patient an injection can lead to an audit. I also read a recent article where an orthopedic practice had to pay back millions of dollars partially for this reason. I typically bill an established patient visit with an injection, but I always add a 25 modifier on the visit. Does that mean I am safe from an audit?

Answer:
Unfortunately, no. It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection. Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M’s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure.

WEBINAR ALERT!
To hear more about how to determine when a visit is “significant and separate” and how to document that “pre-service evaluation” has been exceeded,
join Teri Romano for a webinar on January 9, 2017.

*This response is based on the best information available as of 12/15/16.

Newsletter_Signup_CodingCoaches

Sign up for KZAlertsSign up for KZAlerts

Coding Coaches