Colorado Subscriber Answer: Although not every payer will maintain the same rules on this subject, most carriers maintain strict policies against billing for injectable medication administration (90782, Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular]) and a nurse's visit (99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) on the same date of service for the same patient.
You should bill either 99211 and the medication's J code, or 90782 and the medication's code, but not both.
In addition, you should only report an E/M service with an injection if you fulfill the requirements for appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.
You should remember that the majority of carriers and most private payers would probably not consider the nurse's pre-injection evaluation a "significant and separately identifiable E/M service."
Note: See our article "Joint Injection With E/M? Append -25 in These Instances" on page 11 for more information on how to determine whether modifier -25 applies to your E/M claims.
- You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.