E&M with Minor Procedure

FirstLadi

Contributor
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East Orange, NJ
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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:(
 

michellepilcher

Networker
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Anchorage , AK
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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

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

Here's a great blog post also

https://www.aapc.com/blog/27690-know-when-to-bill-em-with-a-minor-procedure/
 
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CodingKing

True Blue
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NCCI Manual addresses this:

CHAPTER XI

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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