Wiki E/M Visits and Minor Procedures

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Good Morning Everyone,

I have a question regarding billing office visits and minor procedures on the same day.

A physician at our practice has asked us to start billing office visits and minor procedures that occur on the same day on separate claims because of a recommendation he received at a billing and coding conference recently. I let him know we are able to bill office visits and minor procedures on the same claim using modifier 25 as long as the documentation shows the visit and procedures are significant and separately identifiable, but he said that the suggestion was to bill them on separate claims because it has apparently helped other practices with processing claims for both the procedure and E/M charges. We would be billing under the same physician for both claims, so I am not sure if this would work or not. Has anyone else tried doing this before at their office? Just wanted to get some recommendations and see if anyone else had any success billing their claims this way. Thank you!
 
Intentionally splitting claims in order to get around payer denials or avoid multiple procedure payment reductions would be fraud, waste or abuse. If you get audited, there will be a problem. There is a reason why the guideline asks you to add modifier 25 in such situations and does not ask you to split the claims.
 
Intentionally splitting claims in order to get around payer denials or avoid multiple procedure payment reductions would be fraud, waste or abuse. If you get audited, there will be a problem. There is a reason why the guideline asks you to add modifier 25 in such situations and does not ask you to split the claims.
I agree with Medicalauditor - I'd lean towards Fraud for this if intent could be proven.
 
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