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#1
10-12-2009, 03:00 PM
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proper billing of services
I have a Doctor who always does an office visit with the paring or cutting of lesion (11055 or 11056). The e/m is never seperate so there isn't a 25 modifier applied. The question is, does the Doctor HAVE to bill the 11055 or 11056 if done with the e/m visit? The question is coming up because e/m gets bundled into service and is paid as a lower amount. Doctor wants to know if he can just bill out the e/m and not the paring or cutting of lesion. My thought is the service must be billed because it was done. Am I correct in my thinking? Any comments are appreciated.
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#2
10-12-2009, 03:08 PM
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If a code exisits for the service performed then that is the code you select. This is the way it was always explained to me. Why do you say the E&M is never separate? Was the patient scheduled to come in for the procedure? If so I agree no E&M should be charged. However if the evaluation is over above and beyond the evaluation needed just for the procedure then you should have the E&M with the 25 and the procedure with no problem.
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Debra A. Mitchell, MSPH, CPC-H 
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#3
10-12-2009, 03:18 PM
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I am in agreement with Debra.
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Lisa Bledsoe, CPC, CPMA 
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#4
10-13-2009, 06:08 AM
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Yes, the patients are scheduled to come in for the service. If the Dr. is spending more time than usual on the service wouldn't it be more appropriate to put a 22 mdifier on the service. I guess I don't follow why you would put a 25 modifier on the e/m??? If the e/m isn't a seperate service how could the 25 mod. be added? Thanks for the clarification.
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#5
10-13-2009, 06:15 AM
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Ok so they are scheduled to come in for the procedure and for some reason the procedure is more involved? then yes a 22 on the procedure code, but not because he spent time talking to or examining the pt.
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Debra A. Mitchell, MSPH, CPC-H
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#6
10-13-2009, 06:40 AM
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Correct, if the procedure for some reason took longer then adding the 22 mod. would be ok.
But my question was with the 25 mod. comment on the e/m. If they are coming if for a scheduled lesion removal how could you put a mod on the e/m? It's not seperate and distinct from the service. OR ..... Should the e/m not even be billed?
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#7
10-13-2009, 08:24 AM
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Quote:
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Lisa Bledsoe, CPC, CPMA
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