Wiki Anoscopy with office visit

[krssy70]

Hello,

I have a physician that does Anoscopies in the office setting. Is it inappropriate to bill the office visit with the modifier 25 and the anoscopy (46600)? Ex: Pt comes into office with fecal incontenence. Physician does an H&P, ROS and Physical exam and decided to do the anoscopy in the office. Is this billable?



Any help is appreciated,

Thank you

 

[smoore123]

Good Afternoon,

It is difficult to give a definitive answer without reviewing the documentation. I would encourage you to review THE NCCI Coding Policy Manual.

It reads: If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.

Here is a link to the NCCI edit page on the CMS website. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

I hope you find this helpful.

 

[krssy70]

Thank you. That is very helpful.