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E&M, or not to E&M

sjsantjer

Networker
Messages
36
Location
Aberdeen, SD
Best answers
0
Would you bill the E&M? Dr wants to bill:
99213-25
11100

Established Patient

CC: Scalp Lesion
Lesion on back scalp, present a few months, no itching, not bleeding, not painful, not really growing.

KNA

Meds: …… listed.

ROS: Hx of skin cancer. No SOB, No problems with healing. Does not develop keloids after surgery. Does not bleed easily.
Social Hx- non smoker

Exam: Pt is frail and elderly, oriented x 3, affect appropriate, capable of following directions. Scalp/Hair 4cm firm sub q nodule. Head/face/nose/ears, conj/eyelids clear. Neck questionable small node.

Lipoma-Tried to excise without success. Punch bx taken from yellow sub q nodule. Alcohol prep, 1% buffered Xylo w/ Epi, 3mm punch……. Path report to be called. Further Tx based on report. Return 1 week for suture removal.

Pathology- Involved by a low-grade B cell lineage malignant lymphoma. Referred to cancer Dr.

Thank you!
 
Last edited:

missy874

Guru
Messages
171
Location
Albany
Best answers
0
I would bill only the procedure. We follow CMS guidelines and are under Noridian as well. From LCD L10106 :

Medicare will not pay for a separate E/M service on the same day dermatologic surgery is performed
unless significant and separately identifiable medical services were rendered and clearly documented in
the patient's medical record.

This documentation does not appear to support anything separately identifiable.
 

JRaney

Guest
Messages
1
Best answers
0
I agree with "missy874". The notes do not seem to indicate a separately identifiable DX from the procedure.
 
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