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Modifier 25

Marlene Posted Wed 07th of October, 2015 18:03:00 PM

Here is my example -

This is for Pro Fee billing. Physician sees patient on Day 1 and does HPI - Exam - MDM - and decides patient has Bronchitis and orders an IM injection of Rocephin. The doctor then has patient follow up in 3 days. Patient still having rales in his lungs and has no chronic conditions that are addressed. Just worsening of lungs. Doctor orders the nurse to give patient another IM injection of Rocephin 1gm...Same dose as before.

I billed on Day 1

99213-25
96372
J0696

Day 2

99213
J0696

I don't feel that another 96372 can be billed as it was a follow up visit and the same treatment was provided. Can you reference anything to support my decision? I have another coder questioning me and she thinks because the injection wasn't planned or scheduled you can bill the 96372 each time.

SuperCoder Answered Thu 08th of October, 2015 10:27:48 AM

Well, you can bill it for second day also. It is a follow up visit, but there is medical necessity and you are providing your services for the patient, which should be paid. Technically, global days for the injection is none, and medically unlikely edits (MUE) is also none. So, it is advisable to bill it for second day also. Hope it helps!

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