EM Coding Alert
Don’t Mistake These Procedures for E/M Services
Question: I noticed that the physicians at the practice I just started working at tend to bill office visits based on time. They perform in-office procedures, such as nasal endoscopy, sinus debridement, and laryngoscopy, and include the time spent on these services in the evaluation and management (E/M) total time count. I don’t think this is correct. Please advise. Missouri Subscriber Answer: The procedures you mentioned are billable services represented by other CPT® codes — these activities are reported separately and may not contribute to the total time count for a billed E/M service. In other words, you must deduct the procedure time from the total time, assuming the E/M service is reportable. The Centers for Medicare & Medicaid Services (CMS) expects the E/M to consume time separate from the time it takes for the minor procedure. To know what’s allowed, refer to the physician work time file for 2024, which indicates the amount of time the provider may expend for minor procedures pre-service, intra-service, and post-service activities, at www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1784-f. Remember: To bill for an E/M in addition to the minor procedure, the E/M service would have to be significant and separately identifiable, which would then require you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician …) to the appropriate E/M code.
EM Coding Alert
- Coding Deep Dive:
Answer the How, What, When, and Why for Pre-Operative Evaluations
Don’t forget to check for comorbid conditions. Knowing how to navigate and select all of [...] - FAQ:
Seek Clarity on New Pelvic Exam Code
Find out which Medicare codes aren’t compatible. Many coders may not feel confident about using [...] - Specialty Focus:
Find Security in Coding Vertebral Fractures
Hint: Consider E/M code to report the decision-making process. Coders who report surgery know they [...] - You Be the Coder:
Note E/M Exception in Debridement Procedure
Question: I have a provider who uses an operating microscope to debride the ear canal [...] - Reader Questions:
Don’t Mistake These Procedures for E/M Services
Question: I noticed that the physicians at the practice I just started working at tend [...] - Reader Questions:
Remember This Modifier 25 Tip
Question: Should I always append modifier 25 for a minor procedure with an evaluation and [...] - Reader Questions:
Understand Neonate-Specific Coding Conventions
Question: Our hospital physician provided a neonate with critical care throughout the first 28 days [...]
