Wiki E/M with office procedure question?

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kgarcia1

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Hello, I was wondering if someome can help me with a reoccuring question that I have been encountering. If an established patient comes in for an OV with the physician, for a complaint of pain or a complaint of suspicious lesion and we perform an office procedure like bursa injection or shave biopsy, can we bill for the E/M service and the procedure? I appreciate everyones help!
 
It depends on whether the patient came in with the intention of having the lesion removed or joint injection. If they came in for an office visit and decided at that time, then the separate and identifiable E/M should have a 25 modifier and code for the removal. If they were scheduled with the intention of having the lesion removed or joint injection, the E/M portion is inclusive to the procedure and you would use the removal/injection only.

Good luck
 
The patient came in with the complaint and the decision was made at the time of service to do the injection/ biopsy. The patient wasn't scheduled to have a procedure.
 
Thats good, but you still need to bill the o.v. with a separate diag. So if the patient came in with pain, then bill the pain diag with your o.v. and bill the lesion by site for your procedure.
 
Two different diagnoses are NOT required. I am attempting to locate the documentation for this. I will post it when I find it.
 
I thought that was your question????? I have always been paid for both E/M and procedure with 2 different diagnosis. I did NOT say that it was required. It is only the way to bill to get both procedures paid.
 
krssy70 said:
Thats good, but you still need to bill the o.v. with a separate diag. So if the patient came in with pain, then bill the pain diag with your o.v. and bill the lesion by site for your procedure.
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This statement sounded to me like you were saying that the office visit must have a different dx from the procedure. I didn't mean to offend..
 
krssy70 said:
I thought that was your question????? I have always been paid for both E/M and procedure with 2 different diagnosis. I did NOT say that it was required. It is only the way to bill to get both procedures paid.
Click to expand...

The OP was asking about a procedure billed along with an office visit. I don't know what you mean when you say "both procedures".
 
I meant by stating both procedures was the E/M and surgical procedure. You did not offend me, I was just clarifying that I did not mean that it was required. It is just my opinion in my years of billing E/M, that I always use a different diag, and always have been paid. I was only trying to help, the intial person who posted this question, to get her claim paid. Sometimes you cannot bill it with a different diagnosis, and you are forced to bill it with the same diag, in hopes that it will pay, and if not, you only bill the procedure. The modifier 25 have always been interperted different by the majority of coders.
 
I feel I owe an apology for my poorly worded question. I should have used a single example. A patient comes in with a complaint of elbow pain. Apon evaluation it was determined the patient has lateral epicondilitis and an injection of the elbow was done. Can an E/M and a procedure be billed? The patient wasn't scheduled for an injection.
Sorry for the confusion. I am still a student and working with coding at the same time!
_____________
Kelly G.
 
Kelly, I would only code the procedure code, since that is the only thing being treated and that is why the patient came in in the first place. He came in for the elbow pain and the physician treated it with an injection. Now if the patients knee was also sore and the doc looked at that and did an exam, then you could code an E&M along with -25. Does that help?

Never appologize! This is how we all get better at this:)
 
Thats right Kelly, Well said by Ltibbets...Thank you Ltib...

In the future Kelly, if your pt is being seen for a completely different diag, and in the same visit, brings up an issue where the physician decides (in that visit) that it needs to be addressed, (with an injection/excision) then most definetly you can bill both the E/M and procedure with the 2 different diag and the mod 25. Sometimes us fellow coders have to disagree to agree.. :)

Good luck
 
I apologize for misunderstanding your posts. My only point was that 2 different diagnoses are not required when billing a procedure and an office visit on the same DOS, which is what I thought you were saying. Certainly you can use two different diagnoses if they are appropriate.
 
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