Wiki E/M vs Procedures

[jwilson42]

What is the best way to explain to providers that you can't bill for both an E/M and a procedure when the patient was only seen for whatever was done in the procedure? Thanks!

 

[tmorgan808]

CMS has a Global Surgery Fact Sheet - it has some good information for example:
The initial evaluation for minor surgical procedures and endoscopies is always included in the global surgery package. Visits by the same physician on the same day as a minor surgery or endoscopy are included in the global surgery package, unless a significant, separately identifiable service is also performed. Modifier -25 is used to bill a spearately identifiable E/M service by the same physician on the same day of the procedure.

You can also search the Coding Edge for an article called Identify the Correct Global Period E/M Modifier

Hope this helps.

 

[gsweet@umc.edu]

When to bill E/M with Minor Procedure

I have a provider that is billing an E/M along with a minor procedure. Does the scenerio below warrents an E/M with 25 modifier?

Patient comes to the clinic for post for procedure done three months ago for squamous cell carcinoma in situ of the vertex scalp. Exam done, vertex scalp healing well, patient doing well s/p procedure, f/u in three months.

During the visit, patient ask provider to evaluate three new lesions. After evaluation of the new lesions, biopsy was recommended during the same visit.

Provider bills:
99212-25
11100
11101

 

[ollielooya]

.......During the visit, patient askes provider to evaluate 3 new lesions. Aftr evaluation of the new lesions, biopsy was recommended during the same visit."
That statement alone would qualify this scenario for an added EM visit based upon the modifier 25 descriptor.

 

[lhardin0621]

The CCI manual has a great explanation as well.

http://http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html[/URL]