Wiki E&M with exchange transfusion?

[sharlowm]

I have looked all over and can't find anything definitive on this...It looks like you could bill an E/M service with 36455 (exchange transfusion). My issue is that the note for E/M has a CC of "exchange transfusion". She states "Pt returns for a regularly scheduled PRBC tranfusion". She does a complete history and exam, documents labs and states "pt tolerated the partial exchange transfusion without adverse reactions".
My thought is that this IS not a separately billable E/M, she should just be charging for the procedure. To me this is similar to E/M with chemo, you can't bill the E/M if all you are doing is clearing the pt for chemo, you have to be assessing the disease or addressing some other problem.
I know this will create controversy, so want to be sure I am correct.
Anyone have any firm citations or experience with this? thanks!

 

[Lynda Wetter]

I'm not seeing anywhere where it states you can not bill for the E/M. This procedure code has a XXX global day reference which means the global rule does not apply.

 

[sharlowm]

The issue isn't that there isn't any global period, the issue is medical necessity for the E/M when she is also billing for an exchange transfusion. Our carrier has gone on record as stating that when you bill an E/M with an infusion, chemo, etc. it has to be for a service besides the scheduled procedure...in other words, to assess the underlying disease, or a new problem. Then you can bill it with a modifier 25, but otherwise, you shouldn't. I'm asking what others do when they see notes like above. thx.