Wiki billing and E/M with a procedure

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Can someone please settle a debate I have?

A patient was seen in office a few weeks ago and at that appointment it was decided they would come back for a punch biopsy. The patient came in for the biopsy and nothing else was discussed that day. Would you bill the E/M AND the biopsy or only the punch biopsy?

Thanks!
 
When the decision is made at an E/M visit to have a procedure done on a different day another E/M visit it NOT billed on the day of the procedure as a re-exam of the area is inclusive of the procedure. Medicare Claims Processing Manual Chapter 12. If the patient comes in on the day of the procedure and has a problem unrelated to the reason for the procedure than a separate E/M can be billed with modifier -25 appended to the E/M code. Medical necessity must be met for every E/M visit.
 
If the three key components were met during the office visit, why would you not bill an E/M? If the physician did nothing more than look at the lesion and go "oh, we need to do a bx", then I would not bill an E/M. To answer your question both can be billed as long as the key components were met and are medically necessary. I wonder why the patient would need to return to have the biopsy done? Very minor procedure that should have been performed on the date that they were seen.
 
Not sure, it just said pt would return in a week for biopsy. Sometimes when I see this for my office, patients like to wait due to something they have to do after the appointment or for some other reason. I agree with your answer, but have been told otherwise so wanted an outsiders opinion! I do bill the E/M when all 3 components are met, I just like reassurance from others. Thank you!! :)
 
Not sure, it just said pt would return in a week for biopsy. Sometimes when I see this for my office, patients like to wait due to something they have to do after the appointment or for some other reason. I agree with your answer, but have been told otherwise so wanted an outsiders opinion! I do bill the E/M when all 3 components are met, I just like reassurance from others. Thank you!! :)
I'm impressed that you still have an AOL account!
 
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