E & M codes/procedure codes

mjones20

New
Messages
1
Best answers
0
Can you bill for an office visit along with a procedure done in the office?

An example would be:

Patient comes into the office for an exam because they feel they have something in their throat. Physician does the exam and feels that a fiberoptic scope needs to be done. Can I bill the E & M code (99213-25)
and the fiberoptic scope (31575)?

thanks-deb
 

codegirl0422

Expert
Messages
310
Best answers
0
I would think you could not bill both, with the information provided. The E/M is not "Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service". :eek:

Modifier 25 can not be used as decision for surgery. per note under description in Appendix A: "Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery". And px 31575 has a global period of zero, so mod 57 can not be used.

This is the way I understand it, any other opinions?
 

codegirl0422

Expert
Messages
310
Best answers
0
I found this in the manual on the CMS website when looking for something else. Hope it helps. I put the link down there in case you needed it.

B. Injection Services Injection services (codes 90782, 90783, 90784, 90788, and 90799) included in the fee schedule are not paid for separately if the physician is paid for any other physician fee schedule service rendered at the same time. Carriers must pay separately for those injection services only if no other physician fee schedule service is being paid. In either case, the drug is separately payable. If, for example, code 99211 is billed with an injection service, pay only for code 99211 and the separately payable drug. (See section 30.6.7.D.) Injection services that are immunizations with hepatitis B, pneumococcal, and influenza vaccines are not included in the fee schedule and are paid under the drug pricing methodology as described in Chapter 17.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
page 14
 

mmelcam

Expert
Messages
262
Location
St. Louis, Missouri
Best answers
0
What I am getting from the information from the CMS website is that you can not bill for both an ov and the administration of an injection. You can only bill for the ov and the medication given in the injection. This is not the same scenario as giving an injection during an ov. The patient came in because they felt like something was in their throat. The physician did a diagnostic procedure to assist them in what might be causing this and what course of treatment to take. In this case both the ov and the diagnostic procedure are both billable. If the diagnostic procedure does not have a global period then you would not need to use the 25 modifier, however you will find some insurance companies still require you to use it.
 

29078coder

Guest
Messages
4
Location
Capital City Coders
Best answers
0
I work for an ENT speciality group & we do scopes with an office visit. Modifier 25 states you do NOT have to have a separate Dx for the E& M part of the visit. Hope this helps
deb
 

eblanken

Networker
Messages
79
Location
Norman, OK
Best answers
0
Per CMS the mirror exam is included in the E/M and the flexible laryngoscope is only seperately billable if the patient is a child or if there is a failed mirror exam. My physicians know they must document why the flexible scope is warranted other wise it is not billed.
 

LadyT

Networker
Messages
39
Location
Harrisonburg,VA
Best answers
0
Per CMS the mirror exam is included in the E/M and the flexible laryngoscope is only seperately billable if the patient is a child or if there is a failed mirror exam. My physicians know they must document why the flexible scope is warranted other wise it is not billed.
Eblanken,
Thank you so much for that information. Can you tell me were to find something in writing to show my physician that the patient must fail the mirror exam for there to be a seaprate charge for the flexible scope.
 
Last edited:
Top