EM Coding Alert

Question: Is it against the rules to bill an E/M code instead of code 11721?

Maryland Subscriber

Answer: You haven’t supplied enough information to answer your question. Whenever you code, you are doing so based upon the information in your physician’s medical documentation. You must go back to that documentation and see what services it supports. As you go through those details, you should ask yourself if your physician did indeed perform an evaluation and management (E/M) service? If so, was it based on medical decision making (MDM) or time? Or did he just perform a nail debridement service (code 11721)? Or did he perform a separately identifiable E/M service on the same day of service, as well as the nail debridement? In that case, (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) might be warranted. But, to answer these questions, you have to go back to your physician’s documentation. Your answers lie there.