December 28, 2023
If we have an established patient where the physician evaluates the patient and decides to give an injection. The physician documents two diagnoses. May we report an E&M with the injection because we have two diagnoses?
An E&M is reportable with the injection when the significant separate service rules are met.
Two answers apply:
- We do not recommend reporting the E&M if the second diagnosis is at same location or joint that is being injected. In this case, a second diagnosis does not meet the “separate service” part of the modifier 25 definition.
- We recommend reporting the E&M-25 if the second diagnosis if:
- The second diagnosis is in a separate anatomic location from the injection site, and
- The second condition is evaluated and managed.
*This response is based on the best information available as of 12/28/23.