E & m coding

[cgrif2]

I have been out of the coding world for a little while. Need some help on E&M coding. Patient comes in with a couple of nodules on her face and is told to come back 10 days later for removal. New patient E&M is charged on 1st visit. Patient comes back 10 days later as instructed for removal of possible skin cancer(s). Dr wants to charge Existing patient E&M for the 2nd visit. What are your thoughts? Thank You for your help.

 

[thomas7331]

It's hard to say without seeing the documentation. But assuming that a procedure was done on the 2nd visit, and that there were no new complaints or significant changes in the patient's condition or medical history since the previous visit, and no other unrelated conditions being treated that required follow-up, then it's unlikely that another E&M would be justified.

 

[lfoxwell]

Medicare Secondary

We billed a consult code to a BCBS insurance, the patient has Medicare as secondary. The secondary was denied because Medicare doesn't acknowledge consult codes. Can you bill the patient for the balance ?

 

[mitchellde]

no you cannot
If you read in the Medicare manual under consultation and alternative consultation billing it tells you that if the patient has Medicare secondary and the primary accepts consult codes that you can either:
- Bill the primary using the same alternative code you would bill to Medicare or
- Bill the primary using a consult code and write off the remainder

 

[cgrif2]

E&M

Thank You everybody for the info.