Wiki Billing procedure vs E/M

[Cheezum51]

Many procedures are now bundled with the E/M visit. In eye care, we often have patients come in with a chief complaint of foreign body sensation after they get something in their eye. We do an exam to determine if there is a FB and, if it's present, remove it. For billing, we have done a E/M type visit to find the problem and then do the procedure to remove the FB. However, since we've removed the FB, we aren't supposed to bill the E/M with a 25 modifier and also bill the FB removal code, which pays about $22 versus the E/M code which would pay about $80. Instead of billing the low paying removal code, is it OK to just bill the higher paying E/M code which more properly reimburses for the time and effort required?

Tom Cheezum, OD, CPC, COPC

 

[jkyles]

Hi there, if the E/M service is bundled into the FB service, you'll bill the FB. It isn't unusual for higher paying services to be bundled into lower paying codes.