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Wiki E/M Bundled into laceration repair procedure

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burksmail

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Does anyone know if there was a recent policy change stating that the E/M code would be bundled into the laceration repair codes? I've been asked to research this and did not find anything on the CMS website, or any others for that matter. However, I want to be sure of this before I tell the physician there has been no change to using the 25 modifier on an E/M where the conditions have been met.

Thanks so much for any help/direction you can give.

Myra
 
burksmail said:
Does anyone know if there was a recent policy change stating that the E/M code would be bundled into the laceration repair codes? I've been asked to research this and did not find anything on the CMS website, or any others for that matter. However, I want to be sure of this before I tell the physician there has been no change to using the 25 modifier on an E/M where the conditions have been met.

Thanks so much for any help/direction you can give.

Myra
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If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. (Osteopathic manipulative therapy and chiropractic manipulative therapy have global periods of 000.) E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers and A/B MACs processing practitioner service claims have separate edits. The NCCI, Carriers, and A/B MACs processing practitioner service claims do not have all possible edits based on these principles.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.

You can locate this in the NCCI Policy Manual


http://www.cms.gov/Medicare/Coding/...ect=/NationalCorrectCodInitEd/NCCIEP/list.asp
 
I understand there was a language change to this particular section of the NCCI Policy Manual Chapter 1 effective 1/1/13. Does anyone have a previous version of Chapter 1, or does anyone know where I can find the 1/1/12 version (hopefully free version outside of NTIS)?
 
Previous version:


CHAPTER I
GENERAL CORRECT CODING POLICIES FOR
NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL
FOR MEDICARE SERVICES

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers
(A/B MACs processing practitioner service claims) have separate edits. Neither the NCCI nor Carriers (A/B MACs processing practitioner service claims) have all possible edits based on these principles.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician
also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.
 
Thank you Camille! Do you happen to know if the entire 2012 NCCI Policy Manual is available online somewhere for download?

Becky, CPC
 
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