CODING & DOCUMENTATION

The joint injection codes are assigned a zero-day global period, which means that an evaluation and management (E/M) service should not be billed on the same date. This is because the procedure was valued to include the initial assessment and other pre-service work. However, when the E/M service is significant and separately identifiable from the typical pre-service work of providing the injection, the E/M service may be separately reported with modifier 25 attached. An E/M service should not be billed for a planned injection service where the patient presents with no complication or new problem.Your Medicare Administrative Contractor and private payers may provide additional guidance on this subject. For instance, Cigna Government Services and Trailblazer Health have published guidance that says providers are allowed to bill for an appropriate E/M service if they decide to start the series of injections after evaluating the patient during the same visit and their documentation supports the level of E/M service billed.

These vaccines are covered only under Medicare Part D prescription plans. You can either provide the patient with a prescription to receive these from a pharmacy that participates with the patient's Part D plan, sign up to be a provider of Part D vaccines and receive payment directly, or provide the vaccines as an out-of-pocket cost to the patient and provide the patient a claim form to submit to the Part D plan for any benefits payable for out-of-network services. (More information is available on the AAFP web site.)The Centers for Medicare & Medicaid Services (CMS) have developed a quick reference chart for the annual wellness visit that may be helpful.

It is 36416, “Collection of capillary blood specimen (e.g., finger, heel or ear stick).” This code is also often reported in conjunction with screening for lead. Medicare has assigned this code a “B” status, meaning it is always bundled with other services on the same date, but many Medicaid plans provide separate payment due to state mandates for lead screening in children. Private payers may or may not bundle this with other services on the same date; check with those you contract with.