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E&M with Nail debridement

A

aschaeve

Guru
Messages
161
Location
Fond Du Lac, WI
I am in Wisconsin and have NGS as our Medicare administrator. My question is when a new patient comes to see the podiatrist because their feet hurt, and the podiatrist does a full work up to rule anything else out and in the end does nail debridement. Do you bill the E&M along with the nail debridement code? I know the use of the 25 mod needs to be significant and identifiable in order to bill, but when you bill the E&M? NGS has done an audit of the use of 25 modifier with nail debridement and found in most cases the E&M was not warranted. Any help with clarification of this would be great.
 
These are definitely tough. It can feel very gray. I tell the residents in family medicine that I train that if they believe the E/M represents a distinct separate service then write two separate notes in one encounter, an office note at the top and the procedure at the bottom. Also, document your medical decision making and your thought process while evaluating. Our docs do a lot of OMT so when they see a new patient that they have to completely evaluate before they make a decision to do OMT they document well the various Musculoskeletal exams they did on the pt to rule out various conditions.

Another way to look at it is can you level out the visit without the components for the procedure? If so, then it's probably a distinct separate service.
 
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