Wiki E/M coding

[dallas574]

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]

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]

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.

 

[dallas574]

thank you