Ob-Gyn Coding Alert

Question: A new patient comes in for excessive menses for 20 days. The ob-gyn discusses the options and orders blood work. The ob-gyn makes the decision to do a biopsy at this visit. I reported 99203-57 and 58100. My payer denied the E/M as bundled, but that doesn't make sense. How would the ob-gyn know she was going to do a biopsy at this visit when the patient was new? Should I appeal? Texas Subscriber Answer: Yes, you should appeal the denial. Many times, you cannot make a case for an established patient visit with a procedure on the same day. But for new patients not scheduled for the procedure, your practice is entitled to reimbursement for both the E/M service and the procedure. You should have appended modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to [...]