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An Office Visit and an Injection. Can I Bill Both with a Modifier 25?
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…
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.
*This response is based on the best information available as of 12/15/16.
How to Use CPT Codes 64461, 64462 and 64463
There are three new CPT codes our physicians want to use: 64461, 64462 and 64463. What are these codes used for and what are the rules for reporting them?
Question:
There are three new CPT codes our physicians want to use: 64461, 64462 and 64463. What are these codes used for and what are the rules for reporting them?
Answer:
CPT codes 64461-64462 are new codes in 2016 to report a paravertebral (PVB) block and are used to treat chronic pain such as thoracic pain. The procedure involves the physician injecting analgesia in the paravertebral space and includes ultrasound and fluoroscopic guidance. Report CPT 64461 for the first injection and add-on code 64462 for each additional injection. CPT 64463 is only used when continuous infusion is performed via a catheter.
*This response is based on the best information available as of 02/18/16.