E/M and related px same day

cstinson

Contributor
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Tremonton, Utah
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Help!

I'm trying to stand my ground on a work issue and want more opinions. I have always thought that if a patient is est and has a px that has a global period (including preop) the same day, and has nothing else addressed at the office visit that I should ONLY bill for the px. Example, est pt comes in to see the provider and has an office visit and ends up getting wart destruction with liquid nitrogen. No other dx's addressed at the visit. Wouldn't I only bill 17110? Or would I be able to bill say 99213-25 and 17110. I feel this is unbundling to bill both but have had a provider and some coders say I can bill both. I need to know if this is uncompliant to bill both, or if it truly IS compliant and just likely won't reimburse. Opinions please! Thank you.:eek:
 

Lashel

Networker
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In my opinion the E/M could possibly be billed if the provider actually did evaluate and manage. So the question is was history, exam, and medical decision making done, and then based on that E/M decision was made to destroy the warts. If the provider has never seen the patient for this condition before he/she may need to do the work of E/M in order to decide to do the px. For px with a 10 day global use modifier 25, and with px with 90 day global use 57. The main caution here, is documentation documentation documentation!

Lashel- CPC, CPC-I, CEMC
 

mitchellde

True Blue
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13,538
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Columbia, MO
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every procedure has a component the evaluation of the affected site necessary to perform the procedure. Even if this is a new pt, if the evaluation is of the affected site only then you can bill procedure only, however if the provider documents a RELEVANT exam that is over above and beyond the procedure; such as evaluating other body sites; then you may bill the eval and the procedure together using the 25. Remember can you justify SIGNIFICANT and SEPARATELY IDENTIFIABLE E&M.
 

slaforge

New
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Joplin, Mo
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E/M with H&P Same day

What about same scenario as above only........ Patient is seen and decision for surgery is made (90day global)( Lets say for carpal tunnel surgery.)
H&P is performed(by PA) the same day. Assuming documentation supports office visit (whether new or established) can Dr bill for office visit? H&P is included in procedure. Or does physician lose out on any reimbursement due to H&P?:eek:
 

mitchellde

True Blue
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Columbia, MO
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you could not bill under the physician for the PA to see and evaluate the patient, and determine the necessity of the procedure. You can bill the visit under the PA with the 57 modifier but not the physician. If the physician saw and evaluated the patient and then made the decision for the surgery then he could bill the E&M with the 57, then if the PA performed the H&P for the admit, this is not billable.
If the provider saw the patient at a previous encounter and determined the need for surgery at that time, and the patient is now being seen by the PA and surgery is scheduled then this visit is not billable as it is a global preop encounter.
 
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