Wiki E&M/Procedure

[KenyaHoward]

Hello Everyone,

Quick Question.

If there is a visit that has all the requirements for an E&M code but there is also a small procedure performed, is it illegal to only submit the E&M?

Thanks guys!

 

[thomas7331]

It's incorrect coding to do this. If it's done knowingly and intentionally for the purpose of obtaining a higher payment than would otherwise be received, then yes, it could be illegal as that could be considered filing a false claim.

 

[KenyaHoward]

It's incorrect coding to do this. If it's done knowingly and intentionally for the purpose of obtaining a higher payment than would otherwise be received, then yes, it could be illegal as that could be considered filing a false claim.

Thanks Thomas!

 

[csperoni]

I agree if there is a procedure performed that has a CPT code, it is clearly incorrect coding to submit the E/M only instead.
If by "procedure", you mean something very minor, or there is no CPT for, then billing the E/M could be appropriate.
Example: removing sutures placed by a provider not part of your practice. E/M only would be correct.

 

[amyjph]

It really depends on the procedure and E&M level. It's tough to say without knowing the specifics. As you were advised above it could be incorrect coding, but depending on the procedure it might be correct to only submit an E&M.