25 modifier - clinican evaulated

coder1

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Good Afternoon Coding World,


Could I billed for EM if a clinican evaulated 2 pressure ulcer of the buttock , but debrided just one??

eg: 99309 25 707.05 707.22
11043 707.05 707.24
 

btadlock1

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Good Afternoon Coding World,


Could I billed for EM if a clinican evaulated 2 pressure ulcer of the buttock , but debrided just one??

eg: 99309 25 707.05 707.22
11043 707.05 707.24
Not unless the key components of 99309 are documented (2 out of 3 of the following:
Detailed interval history, detailed exam, moderate MDM). Simply looking at a second pressure ulcer in the same location as the one debrided, isn't enough on its own to warrant billing another E/M service. The E/M has to be significant/separately identifiable from the debridement to be reported.
 

coder1

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Thanks for your prompt response...I agree 100% but in our clinican eyes "I should be reimburse for evaluating the second ulcer. The problem I have is finding edvidence to support that in this case the dx don't support the E/M
 
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