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Wiki Billing E/M with a COLP

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owenstonya

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Puyallup, WA
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Hello,
One of our MD's counsels her patients extensively re: the procedure, what happens, what LGSIL,HGSIL, HPV etc is. and also what to expect after the procedure.

Would it be correct to bill E/M level with mod. 25 and the colpo code; same DX?

Thank you!
 
If the patient is coming in to get her test results and the doc decides to perform the procedure on the same day, then yes.

If the doc sees the patient, explains the results and then schedules her on a different day to perform the procedure, then No. Even if the doc goes back over everything.

You can use the same dx code and bill the E/M as long as you have the proper documentation that the patient initially came in for one thing and ended up having the procedure also. If the doc says "follow up colpo in 6 months" and the pt comes in for a repeat colpo in 6 months then you can not bill an E/M due to you knew she was coming in to have that procedure done (unless she has something else wrong that she wants to address).
 
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If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical 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 does contain some edits based on these principles, but the Medicare Carriers have separate edits. Neither the NCCI nor Carriers have all possible edits based on these principles.
Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.

From what I am understanding from above, the DECISION to to peform the procedure on a "minor" service is NOT sep. reportable with E/M, but anything sig. and sep. CAN be (counseling on the procedure what to expect, what the effects are etc.) Can someone please help!!!

Thanks!
Tonya
 
We just saw a new patient who came in for bleeding. A full exam was done and the doctor did perform a Colpo on the same day. So the E&M was warranted as he didnt know what he was going to do until he examined her, and he had never seen this patient before. Generally our physician will bring them back in just for the Colpo. Hope this helps.
K. Albert,CPC
 
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