Wiki Does Pre-transfusion testing require an E/M charge because of MDM?

[garciacrystal5@gmail.com]

I'm auditing a provider in Pediatric Oncology that insists that the visit on Day A requires an E/M because they are doing lab tests to determine whether or not the patient needs a blood transfusion when they return the next day. The provider does not see the patient. The patient then comes in on Day B and gets a "full" E/M in addition to the transfusion. I personally do not believe that an E/M visit is warranted in Day A, but am curious to see if anyone has come across this or has any references I can show this provider group.

 

[Jennifer.White@atg.in.gov]

If all they're doing is the lab tests, I would disallow an E/M billed when I audited. If the physician saw the patient prior to day A to determine what labs are needed then that may be an E/M though.

 

[tkermode]

The provider does not see the patient.

This is your clue here. The provider can not bill an E/M if they do not see the patient. All E/Ms are inherently face-to-face services, unless the CPT states otherwise.