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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