I need your opinions and advice about the appropriate use of Modifier 25. This is a common scenario in which my doc will indicate the need for modifier 25. Please let me know your opinion on it.
The patient is referred to us as a new patient for an injection. We schedule the pt, the dr sees the pt, dictates a complete and perfect level 3 or 4 new patient evaluation. The Dr then, during the same session, performs the injection that the pt was referred for. The Dr completes a separate procedure note for the injection. When the superbill is submitted to the billing team the codes selected are 99204-25, 62321. With the information that I have given, do you believe it is appropriate to bill for the initial evaluation separately? It seems to me that the initial eval shouldn’t be coded in a case such as this. But the argument from the docs/management is that the workup that is being done in the inital eval warrants the separate billing of the E&M. I agree that they are spending a lot of time visiting w/ the pt and doing the appropriate work involved for their coded level of E&M. But I get nervous because the pt was referred for an injection, and they got that injection that same day. Is the extensive separate documentation for the E&M sufficient to bill? Please help!