Documentation - OV vs. Injection or Cast Application

Hello,

I'm looking for some support on the scenario below...

One of my colleagues believes it is okay to omit billing an injection or cast application and bill the office visit instead. She says she wants to do this because the reimbursement is higher for the office visit when compared to the injection or cast application. My initial thought is that this is not a good idea - it appears to be dancing around bundling edits to obtain higher reimbursement. My second thought is that we are to code to the highest specificity...the office visit code does not tell the story of all services rendered when an injection is performed or a cast is applied. Am I over thinking this? If the office visit is related to the procedure performed, I feel like the office visit bundles and the procedure should be billed regardless of reimbursement. 

Any guidance, documentation, or literature in support of either opinion is appreciated.

Thank you! 

Comments

  • This would be considered unbundling and incorrect coding. Every procedure has a built in e/m service so billing just for the OV and not the procedure would not tell the whole story of the encounter.
    It would be like a medial or lateral meniscectomy with chondroplasty. The meniscectomy code (29881) includes chondroplasty (29877) but 29877 alone reimburses higher. A physician can't bill for the 29877 instead of billing the 29881 (which encompasses everything done). This is a surgery example, but the same concept would apply with an OV and injection or cast application.
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