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Coding an Avastin Injection and Office Visit

Pat Posted Wed 02nd of May, 2012 19:03:54 PM

An AMD-wet patient comes into the office for exam and the doctor determines that they would benefit from an Avastin injection '67028' & 'J3590". Can we bill for the office visit with the 25 modifier?

The same patient comes in for follow up in one month, the doctor determines that they would benefit from a second Avastin injection. Can we bill for the office visit with the 25 modifier?

SuperCoder Answered Wed 02nd of May, 2012 19:57:47 PM

Yes you can code office visit with a 25 modifier in your case.This modifier must be appended with an E/M service. This is the modifier you will need to use with the evaluation and management service done on the same day with other procedure done by the same physician. It has to be above and beyond the usual preoperative and postoperative encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different diagnosis reported. The most important thing is that, the E/M level should meet its key
components or if it is selected based on time spent with the patient (counseling and coordination of care). You have to be careful in using this modifier. It must meet medical necessity. As you know, there are procedures that already includes all other coordination of care and management.

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