I understand that insurance companies are cracking down on the use of modifiers as well as the billing for E/M visits. I have to admit I am a little confused on when it is appropriate and when it is not appropriate to use modifier 25 with an E/M…

Is is right to believe the following:

New patient with injection=E/M + Injection code but no modifier necessary
Established patient being seen for new problem with an injection=E/M + modifier + injection code
Established patient being seen within the last 6-12 months for the same diagnosis receiving an injection =injection code BUT NO E/M as it is included in the procedure code
Established patient seen more than a year ago no being seen with an injection=E/M + modifier+ injection code

I look forward to your assistance in this issue. = ) = )