EM Coding Alert

Question: Is there anything I can do from a coding perspective to prevent bundling denials when my interventional radiologist performs an office procedure with an evaluation and management (E/M) service?

Michigan Subscriber

Answer: Because your job is to exclusively translate the provider’s services into codes for the payer, your hands are tied. You have to follow the guidelines and stay compliant.

However, keeping in constant communication with the billing department could help to streamline these services. If they make you aware that a particular code is frequently denied when billed alongside an E/M service, you can send the claim both electronically and on paper in anticipation of an electronic claim denial. You should work in conjunction with the billing department to make sure the paper claim includes all the necessary documentation, including operative report and chart/physician notes, to help justify reimbursement for both services.

You can also work closely with your providers to ensure that the documentation supports the significant, separately identifiable evaluation and management (E/M) service along with the minor procedure note so that when appeals are sent in, the practice successfully demonstrates to the third-party payers that both the E/M and the endoscopy are payable. The billing department can also develop a templated appeal letter to streamline the appeal process for these regular denials.