Wiki CPT code 95251

[Barbara A. Love]

CPT code 95251 ACGM - interpretation and report.

I have a physician that wants to also bill for a E&M visit to give the results to the patient. I explained to him that in order to bill an office visit (99212-99215) separate from the interpretation, he would need to document what was discussed and the changes he made to the patient's medical regimen based on what he interpreted.

He would not be able to bill an office visit to just give the results of the test, because he was already being reimbursed for the interpretation.

Of course I am in the dog house..Opinions?

Thanks,

Barbara

 

[kmhall]

Look at the instructions in parenthesis at the end of codes 95250 and 95251. They both state, "Do not report ... in conjunction with 99091. If you look at the use of code 99091, it states, "Code 99091 should be reported no more than once in a 30-day period to include the physician or health care provider time involved with data accession, review and interpretation, modification of care plan as necessary (including communication to patient and/or caregiver), and associated documentation.

It appears that unless an evaluation and management service was performed, it cannot be billed, and, codes 99250 and 99251 already include the time he spent communicating the results to the patient. I don't think an E & M is appropriate for this situation. That's just my opinion.