E/M level with same day procedure

JKRemmers

Guest
Messages
6
Best answers
0
EXAMPLE: MEDICARE Patient presents for hypertension visit, and then requests a lesion be checked. Provider documents HTN visit, then assesses lesion, and asks patient to return for lesion removal next week due to time.
Patient returns following week for removal. At this second visit, no other systems addressed, no other complaints.
I cannot assign an E/M level to second visit due to the fact that there is not a "significant, separately identifiable" service. Is this the way I should be reading this? My admin. wants biller and myself to add level 2 to the lesion removal procedure code to send in. I just don't feel like it should be added. The second assessment of lesion is short, and should be included in the procedure bundle...? Thanks.
 

CodingKing

True Blue
Messages
3,955
Best answers
1
E&M is bundled into same day minor procedure. As you suspected the decision to do the procedure has already been made and the minor evaluation of the lesion is included in the procedure. The E&M would likely have been separately reimbursable had they been done on the same day due to the Hypertension and the lesion was a "oh, by the way" kind of situation.
 
Last edited:

JKRemmers

Guest
Messages
6
Best answers
0
Thank You for response.
Anyone else want to chime in? I'm in need of opinions to show my admin. that I am not the only coder out there who feels this way.
 

thomas7331

True Blue
Messages
3,152
Best answers
10
I agree. If the lesion was already assessed at a previous visit, the decision to perform a procedure already made, and there is no new complaint or change in the patient's condition, then there is really nothing to support medical necessity for a second E&M service. This is pretty well spelled out in the CMS Global Surgery Fact Sheet (link below) - see the box at the top of page 3 - you might find this a helpful resource to show your providers.

https://www.cms.gov/Outreach-and-Ed...oducts/Downloads/GloballSurgery-ICN907166.pdf
 

JKRemmers

Guest
Messages
6
Best answers
0
Thank You!! I looked at that link, and printed it to add to my research. This is very helpful and very much appreciated!
 
Top