• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

E/M with Minor Procedures

rbynmnk

Contributor
Messages
17
Best answers
0
Can anyone provide assist us in clearing up the confusion of billing E&M codes when “minor” procedures are performed?

Does the policy change if the “minor” procedure is performed at a hospital setting?
How does this affect billing an E&M code with a minor procedure for a new patient?

We have received conflicting information regarding billing an E/M with a minor proceure. Some documentation states you can never bill for an E/M with a minor procedure and other documentation states you can.

Any information would be greatly appreciated.
 

jimbo1231

Expert
Messages
370
Best answers
0
Minor Procedures

Most of the procedures perfromed in the ED such as Lac Repairs, I&Ds etc are minor procedures. Minor procedures are usually defined by 10 or less global surgery days. I haven't seen anything in a long time indicating that an E&M cannot be coded with minor procedures. And since most patients in the ED are new to the physician a work up is required in addtion to the procedure. Most payers require a 25 modifier with the E&M.
Years ago there was language in the CPT and an odd code that was to be used with minor procedures. I think that has been out of the CPT since the 90s. But that might be the source of some of the confusion.

jim
 

jimbo1231

Expert
Messages
370
Best answers
0
A new word. Perfromed

Just realized that I was on E&M not ED. But the same holds true for other hospital sites. There might be more cases say with inpatients where the patient is known to the physician already and an E&M might not be medically necessary and shouldn't be coded. But there is no restriction on coding E&Ms in addtion to minor procedures if the E&M is documented and medically necessary.
And I meant to say performed.

Jim
 
Top