The proper way to code this visit is as 20610, 20610-59, 90772-GA. You could not code an E/M visit because there is no documentation of an examination being done. Because the shoulder and the elbow are both large joints, you would use a -59 modifier on the second code to notify the carrier that the injection was for a different area of the body. The Enbrel injection is not covered by Medicare, so you would need to have the patient sign an Advance Beneficiary Notice (ABN) before the service was performed. Without a signed ABN, the patient would not be liable for the charge. The GA modifier notifies Medicare that an ABN is on file.