Wiki E&M with Minor Procedure


East Orange, NJ
Best answers
Good Afternoon,

Is there any edit or information that can assist me with explaining to the physician that you can not bill an E&M for every new patient visit? Also, the physician is trying to bill an E&M with almost every debridement that he does, even though it is not for a separate issue of the wound procedure.

Please help:(
Per CMS:

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 package,
unless a significant, separately identifiable service
is also performed. Modifier -25 is used to bill a
separately identifiable evaluation and management
(E/M) service by the same physician on the same
day of the procedure

Here's the actual fact sheet

Here's a great blog post also
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NCCI Manual addresses this:


U. Evaluation and Management (E&M) Services

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. (Osteopathic manipulative therapy and chiropractic manipulative therapy have global periods of 000.) In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.
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