Wiki E&M Question


Best answers
Hi Everybody, I have a question I hope someone out there can help me with. Recently, we had a patient new to our practice present with a breast mass, after evaluating the patient, the doctor had a pathologist perform an fna in our office, after which the patient left the office. The results came back the same day with findings of primary breast carcinoma, at that point the physician had the patient return in order to discuss these results, and also talk about possible placement for a venous access port. Is it possbile to charge the two visits for this one date of service?
Thank you for any input

Melissa Bell, CPC
Answer to question.

Your going to get alot of back and forth answers on this question. I believe partially everyones right. But I have a copy of medicare guidelines regarding the use of modifier 25. It states that you can bill two E/M on the same day at different times. But they have to be unrelated. For example came in to check up on Hypertension. Then returned later, for a sprained ankle because he was playing ball with his boys. You see.

So pertaining to your question, My opion is to bill them out, appending a modifier 25 to the latter visit. But also make sure the two DX are different on the E/M. Like benin on the first encounter, then Carcinoma on the latter. No guarentee you'll get reimbursed on both. But if you have two serparate notes to justfy it. You can appeal. Trick to the trade.

Daniel CPC