Coding E/M and procedures

[brandytony]

Good afternoon, we are encounter based for Medicare and Medicaid and therefore cannot be paid unless there is an E/M attached to the claim when there is a procedure done. In this scenario is this appropriate to code an E/M and procedure in order to get some type of reimbursement?

 

[thomas7331]

Good afternoon, we are encounter based for Medicare and Medicaid and therefore cannot be paid unless there is an E/M attached to the claim when there is a procedure done. In this scenario is this appropriate to code an E/M and procedure in order to get some type of reimbursement?

Procedures are still encounters - I have never heard of an arrangement that would not reimburse procedures, but if that is the case, I think this is a question you'd need to refer to you contract or ask your payer for guidance on. It's not appropriate to code outside of the accepted guidelines just to get payment unless you have something in writing from the payer instructing you that they want you to report that way. What kind of facility or practice do you work for and can you give a little more information about the encounter based arrangement you have? Perhaps with more information we could help a little more.