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E/M & Fistulagram

Lynda Wetter

Lynda Wetter

True Blue
Local Chapter Officer
Messages
515
Location
Glen Allen, VA
If a PT comes in for a planned Fistula (36147) is it appropriate to bill for an office vist. I think the answer is no! Confirmation or other reasoning is greatly appreciated!!!

Thanks, Lynda CPC
 
My first instinct would be no,

The only way it would be paid in addition to the procedure would to be to add the -25 modifier.

If you look at the definition of the -25 modifier

Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service

If the physician addresses an entirely different issue, then it could be possible. But documentation would be vital.

HTH

Heather Shaw, CPC, CIRCC
 
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