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05/20/2021 Ron Werter, DPM
Office Visit and Injections (Kelsay of Paul Krestik, DPM)
I suggest that the rejection is solely due to the -25 modifier. The insurance companies have decided to find another way to not pay for our services.
Question 1 - How can an E/M code which is supposedly included in a service pay more by itself than the service it is part of?
Question 2 - Recently an established patient returned with a new problem. I did my workup including a diagnostic ultrasound (76882) and determined it was an inflamed 1st MP joint. She was in great pain so I gave her an injection (20600), Not with US guidance. Insurance did not pay for the diagnostic US saying it was part of the injection. I was told I was lucky they did pay for the office visit. They did pay for the injection (20600) So I got paid for the 3rd level visit (99213-25) and if I billed as they wanted would have gotten paid for a 20604 (guided injection) even though I did not use the US for guiding the injection. This particular insurance company pays $38 for a 76882, and pays $58 for a 20600. They pay $79 for a 20604. I just lost $20 for using the US for diagnosis..
I could done my workup using the ultrasound, made my diagnosis, and sent the patient home with a Rx for NSAIDs and ice and had her come back in 3 days, If on her return visit, I gave her an injection 20600 (without using the ultrasound), would that be proper?
Day 1 99213, 76882. Return appointment 20600 +"J" code. I would have gotten paid for everything I did, but at the discomfort of the patient who had suffer the pain for 3 days and to return another time and maybe another copay.. (Some of the managed care companies make it easy, because we have to get prior approval for an injection, so the patient has to come back). How do we correlate our desire to help the patient, with the fact the insurance company will not pay us to treat the patient properly and efficiently.
Ron Werter, DPM, NY, NY
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