Injections and E/M Visits
Question:
How do you code for an unplanned injection as well as the E&M service necessary to make the decision to perform the injection?
Answer:
The answer to this question depends upon if you are providing a significant and separate evaluation and management service in addition to an injection, and not whether the injection was planned or unplanned. Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M’s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure. Just because an injection is unplanned does not automatically allow for an E/M visit to be billed. There must be a significant and separately identifiable E/M service above and beyond the injection. Please listen to our KZA KAST Modifier Monday podcast on Modifier 25 for additional information.
*This response is based on the best information available as of 11/20/25.
