Wiki to use -25 or not to use

[catharine]

My doctor seems to feel that when he preforms a pessary and then discusses the procedure after placment he can bill a level 4 visit for spending time discussing the procedure. I feel that since the procedure was scheduled and everything discussed on the first visit this should not be charged. Any thoughts?
He also likes to charge an E&M with a cystoscopy. If planned should this not be part of the procedure?

Thanks

 

[Saedron]

Here is a link I reference often. Scroll down to the examples. Looks like yours is close to example 3.

 

[Saedron]

Well, crud. The link

http://www.palmettogba.com/palmetto/webtool.nsf/vtool/mod25

 

[stmonte823]

to -25 or not to -25....

Separate and distinct is the key here. If they come in for hearing issue, and the doctor removes an impaction, they can only bill EITHER the visit OR the procedure (in this example, most lean to the office visit as it pays more than a simple ear-impaction removal).

Time is not the issue...just IF there was a separate and distinct issue addressed. In the example above there was not. Discussing the issue surely puts the patient at ease, but its still the SAME issue, not separate and distinct.

Same patient, but after clearing the ears they mention an odd lesion on their arm....or a swollen knee....or discusses ANY other, unrelated issue. NOW the doctor can bill both the procedure with its distinct DX, followed with an office code and -25 with its differing distinct DX. Notes should support both dx, both services/procedures in a clear, concise manner. Modifier -25 records are not the time to be fuzzy/unclear in your notes.

Refer to the recent issues of our magazines....-25 is a hot button for audits last year and this year. A 'double dip' is not worth the potential greif of an extended audit...or worse...givebacks! (...or worse.../gulp)

Happy Coding!

 

[lstaniscia]

my doctor seems to feel that when he preforms a pessary and then discusses the procedure after placment he can bill a level 4 visit for spending time discussing the procedure. I feel that since the procedure was scheduled and everything discussed on the first visit this should not be charged. Any thoughts?
He also likes to charge an e&m with a cystoscopy. If planned should this not be part of the procedure?

Thanks

no office visit should be billed at all if the procedure was planned.