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Wiki Consult with procedure (Help)
- Thread starter broundy
- Start date
To broundy-Consult with procedure (Help)
Technically a consultation should not require a modifier simply because of the nature of the service. In reality, there are several payers that do require it to be appended to the E&M code when it is reported on the same date as a procedure/diagnostic test, etc.
I would be more concerned that the E&M service actually meets the criteria to be reported with a consultation code.
For example, a family medicine provider requests a diagnostic test from a specialist via an order for an EMG study and instead the specialist bills a consult in addition to the diagnostic test. In this scenario there is no request for a consultation so it would be wrong to report a consultation. Part of the EMG service is to issue a report which contains the findings and recommendations. A consult is designed to provide similar information. For this reason it seems unacceptable to bill for an EMG and a consultation the same evaluation. Of course there are always exceptions and based on what information you provided, my educated “opinion”
is that the provider should not report a consultation and an EMG at the same time. I am pasting the link to an interesting article regarding EMG documentation and reporting. I hope it is helpful.
http://www.aanem.org/PracticeIssues/PositionStatements/documents/RptResultsEMGNCS.pdf
Technically a consultation should not require a modifier simply because of the nature of the service. In reality, there are several payers that do require it to be appended to the E&M code when it is reported on the same date as a procedure/diagnostic test, etc.
I would be more concerned that the E&M service actually meets the criteria to be reported with a consultation code.
For example, a family medicine provider requests a diagnostic test from a specialist via an order for an EMG study and instead the specialist bills a consult in addition to the diagnostic test. In this scenario there is no request for a consultation so it would be wrong to report a consultation. Part of the EMG service is to issue a report which contains the findings and recommendations. A consult is designed to provide similar information. For this reason it seems unacceptable to bill for an EMG and a consultation the same evaluation. Of course there are always exceptions and based on what information you provided, my educated “opinion”
is that the provider should not report a consultation and an EMG at the same time. I am pasting the link to an interesting article regarding EMG documentation and reporting. I hope it is helpful.http://www.aanem.org/PracticeIssues/PositionStatements/documents/RptResultsEMGNCS.pdf
Consult and procedure
Thank you for your reply. I do understand what you are saying and I did not explain this very well I am afraid. She does meet the criteria for the consult and decides many times at the consult that testing is needed, so she does it on the same day. Am I wrong in thinking that when you add a 25 modifier the payment is reduced? I am not sure where I got this information but it is stuck in my head
Thanks again for any help! Bonnie
Thank you for your reply. I do understand what you are saying and I did not explain this very well I am afraid. She does meet the criteria for the consult and decides many times at the consult that testing is needed, so she does it on the same day. Am I wrong in thinking that when you add a 25 modifier the payment is reduced? I am not sure where I got this information but it is stuck in my head
Thanks again for any help! BonnieFTessaBartels
Guest
25 does NOT reduce payment
The -25 modifier does not reduce payment. In fact, it allows for payment for the "Significant, separately identifiable" E/M service on the same date as a minor procedure.
F Tessa Bartels, CPC, CEMC
The -25 modifier does not reduce payment. In fact, it allows for payment for the "Significant, separately identifiable" E/M service on the same date as a minor procedure.
F Tessa Bartels, CPC, CEMC
1071471
Networker
I agree that modifier 25 does not reduce payment, it's quite the opposite. Maybe you were confused with the 52 modifier?
Happens to the best of us !!!
Happens to the best of us !!!