You Be the Coder:
Billing E/M Services With Cardiac Catheterization
Published on Sun Dec 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: If we decided to perform a cardiac catheterization based on the results of a MIBI [thallium/technetium sestamibi] stress test and we have never seen the patient face-to-face, can we still bill the visit before the procedure?
Maine Subscriber
| Answer: To bill for an E/M service, the provider must take the examination and make medical decisions based on the information obtained in the history and examination on the same date of service. All three components must be present to bill for an admission (99221-99223), a consultation (99241-99255) or a new patient visit (99201-99205). If you are billing an E/M on the same date as the stress test or other service, you would append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service to show that it is separately payable.
For example, if the cardiac catheterization is scheduled from abnormal test results and the physician has never seen the patient and the patient is scheduled to come in early so that the physician can perform a total E/M evaluation prior to the catheterization to determine whether the patient needs to have the procedure done, then you would bill for the E/M service. If the provider does not take the make medical decisions based on the exam, however, then you cannot bill for an E/M service. The same would be true for an evaluation prior to pacemaker installation or battery replacement. To bill for an E/M evaluation, the evaluation must take place.
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