E/M coding

dallas574

Networker
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Milwaukie, OR
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I have a couple of ?'s. If a routine physical is done and the physician finds a new problem and sends pt. for an u/s can I charge a regular E/M with a 25 on it?

And.. excision is done, but physician documents enough to qualify for an E/M can you charge for that. The excision was a pre planned appt. Thank you everyone.
 

m.j.kummer

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Local Chapter Officer
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JCMO
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Based on information provided... no additional evaluation and management service is supported.

Case One: "If a routine physical is done and the physician finds a new problem and sends pt. for an u/s can I charge a regular E/M with a 25 on it?"
If the ultrasound findings result in an additional visit where there will be further evaluation and then management of the finding, the provider would bill for the additional visit, typically a different date.

Case Two: "excision is done, but physician documents enough to qualify for an E/M can you charge for that. The excision was a pre planned appt."
The decision for the excision is made at a previous visit, the only medically necessary evaluation and management service is to verify that the patient is still medically stable for the procedure and is not separately billable.
 

tpontillo

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Lauderdale Lakes
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I have to disagree on case one. If the physician performs a physical and finds a problem and addresses the problem then yes you can bill the ov with a 25 modifier. Make sure he did address the problem and their is enough info to bill the ov.
 
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