Question 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!
 
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Hamilton Township, NJ
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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.
 

Orthocoderpgu

True Blue
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Salt Lake City, UT
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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.
 
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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!! :)
 

Orthocoderpgu

True Blue
Messages
1,383
Location
Salt Lake City, UT
Best answers
6
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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