Wiki E/M and Procedures

[salorn88@aol.com]

Can an E/M be billed when a procedure is performed for the same dx?

For Example:

Patient is seen for verruca vulgaris and given a full body exam and HPI and Rx is given during that time. But the doctor decides he is going to perform cryotherapy for that Dx also can we bill for E/M along with the procedure?

 

[ehanna]

We do if the decision for cryo wasn't made on a previous visit. Make sure you append the 25 modifier to the office level. I hope this helps

 

[salorn88@aol.com]

So we can bill insurance for the e/m and procedure with only the one dx?...as long as it wasn't documented on a previous visit?

 

[ngaines1976]

Global Surgery Guidelines for Minor Procedures

Medicare allows payment for an E/M service performed on the same day as a surgical procedure, if all requirements are met. The term surgery or service includes therapeutic injections and wound repairs. The additional E/M service must be separately identifiable from the surgical procedure and require significant effort above and beyond the usual pre and postoperative service routinely required for the procedure. The term separately identifiable means an additional service is not part of the surgery or procedure. Medical records should document the E/M service to such an extent that, upon review, the extra effort may be readily identifiable. The E/M service must require additional history, exam, knowledge, skill, work time, and risk, above and beyond what is usually required for the surgery or procedure. Note: The initial evaluation for minor surgical procedures and endoscopies is always included in the global surgery package. Visits by the same physician on the same day as a minor surgery or endoscopy are included in the global package, unless a significant, separately identifiable service is also performed. Modifier -25 is used to bill a separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure. CMS Global Surgery Fact Sheet ICN 907166 February 2012

 

[debbiebehrens]

E/m coding

If the Dr. is going to do a procedure in a week on a patient and it is documented to do this do we charge an office visit on the procedure date. And if they are going to do the procedure in a month from the visit do we also charge on this.