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Can I bill an E&M for a scheduled procedure

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Woodbridge, VA
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I have a question about whether or not I can bill for an E&M with modifier -25 in the following scenario (I'll be brief):

A patient comes in to see the urologist for a bladder scan that was planned and scheduled a month prior. The doctor documents there has been no improvement since the last visit and goes over the same treatment options that were discussed at the last visit. No new medication was prescribed and patient will continue on the same medication.

Is 99213 -25 the correct E&M service? Or no E&M at all?

Zaida, CPC
 

dmaec

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Hibbing, Minnesota
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I don't see why the doc can't charge an E/M, (not sure if his documentation would support a level 3 - you'd have to score it out to see) - I don't see a need for a .25 modifier either, as I don't see a procedure being done at this visit. It might support a level 2 visit ... Bladder Scans don't have a global period. I think it was an review of things/issues/etc and the doc can charge an E/M, documentation supporting of course.
{that's my opinion on the posted matter}
 
Messages
119
Location
Woodbridge, VA
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Thanks to everybody for your input. I don't think we can bill the E&M either. In reply to Donna's response, even though the bladder scan does not have a global period, it is still defined as a procedure. But again thank you. :)

Zaida
 

dmaec

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Zaida, yes that's correct, the scan is a procedure - maybe I read the post wrong, but I thought you said the scan was done a month BEFORE the office visit right? (not the day you're speaking of now) ..the day of service you're speaking of now is an office visit correct? provider reviewing the scan with no new plans or changes...... why wouldn't the office visit be coded?
Maybe I'm missing something, can you tell me why you think this E/M shouldn't be billed out?
going by what your original post question was - there's no reason not to bill an E/M that is supported by documentation. UNLESS the provider wants a "no charge" visit.

THANKS!
 

dmaec

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{{shrugs}} I don't know mbort - :confused: I'm confused. I read the post as the patient came in a month prior for a visit and had the scan, coming back now basically as a "follow up" of sorts, going over results, etc - even though no changes to speak of - the provider still went over things, time spent with patient, and there isn't a global issue preventing a charge for the E/M, ...so I'm not sure why the E/M can't be coded and billed out...
I must be missing something...
 

dmaec

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Hibbing, Minnesota
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planned and scheduled when? Planned and scan done a month before - and planned come back in one month for follow up? or planned a month ago and coming now (a month later) for the scan? if that's the case, then probably just the scan only. But if the scan was done a month before the office visit - then I'd say yes -the E/M can indeed be coded/billed.....
(I hate to be rock here, but I'm not getting it)
 
Last edited:

Anna Weaver

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Kokomo, IN
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E/M and scheduled procedure

Sounds like they came in a month ago and saw the Dr. The Dr. said come back in 1 month and we will do the scan. Then the patient returned in one month and the Dr. did the scan and also charged an E/M. If this scenario is correct, I do not believe he can charge the second E/M, just the scan.
 

dmaec

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Hibbing, Minnesota
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FINALLY! I get it! LOL... it WAS planned and scheduled a month in advance!
sheesh! sorry about that... I thought they already had the scan done and was coming back in for follow up... my mistake!

I agree with mbort and lphillips (due to my new found knowledge) they indeed are correct.

(it only takes a house to fall sometimes) ;)

thanks to you too Anne ... :)
 
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