Question: A family physician performs a preoperative physical with an electrocardiogram (ECG), a Depo-Provera injection, and an ear flush on a Medicare patient. How should I charge the three procedures?
New York Subscriber
Answer: Depending on your carrier, you should probably report the procedures with 93000, J1051 and 69210 or 93000, J1051, 9921x-25.
For the ECG, if your FP has the machine and provides an interpretation and report, you should assign 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). If the patient went to the hospital for the ECG, and your physician then interpreted the results, you would instead use 93010 (... interpretation and report only).
You should report the Depo-Provera with J1051 (Injection, medroxyprogesterone acetate, 50 mg). Whether you may bill 69210 (Removal impacted cerumen [separate procedure], one or both ears) for the ear flush depends on your Medicare carrier's local medical review policy (LMRP). If your LMRP requires instrumentation, such as forceps, to report 69210, you may consider billing a separate low-level E/M for the service instead of the cerumen removal code.
For instance, if your FP performs and documents the services he provides to protect the patient from iatrogenic injury (pre-Depo-Provera injection services) and to flush the patient's ear, you could combine these E/M components and report the appropriate service code, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...). You would then append modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 9921x to indicate that the injection and ear procedure's history, examination and medical decision-making are significant, separate services from the preoperative exam.