Wiki Billing E/M codes with new MDM guidlines

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heatherbee

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I just took the 2021 E/M Guideline Changes workshop for Dermatology and when it came to doing the case studies I became confused. They were billing high level codes for an OV when a biopsy or surgical procedure was performed. I am confused because we have always been told that with just the procedure being performed that you can't really bill an E/M code and get paid. I have to appeal many E/M codes now when there is a separate visit and 25 modifier. So are the new guidelines going to allow us to bill E/M with the procedure? Then I would think a 25 wouldn't be appropriate since it is related to the procedure. I did reach out to AAPC, but they have a 5-7 day response time. Just trying to get started on what we need to do. Thanks, Heather
 
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I paid for and saw the same workshop and I found that to be an issue too. She gave bad examples because all the examples given included minor procedures. All of the cases she used, we should not bill a e&m separately with those minor procedures. I heard there will be a "modest" rate increase for e&m codes in 2021 so I doubt that means we should be billing a unjustified e&m with a minor procedure. I feel like I wasted money on the work shop some what to be honest because of those case studies she used all involved a minor procedure but not much about the category of medical conditions, which is probably the most gray area.

This post from the AMA might be more helpful and it's free. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
 
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