Wiki E/m with procedure

[poshley203646]

Patient came into the clinic with a laceration the provider sutures the laceration would I bill just the laceration repair or would I bill the laceration with an e/m visit with a modifier and the repair

 

[cynthiabrown]

you would only bill e/m if it was seperately identifiable. My guess is by nature of encounter, there was not a seperate e/m.

 

[Leenahz]

^ Yes, laceration repair only.

Lena

 

[Saedron]

I differ.

If the patient presents with a laceration, and a significant amount of work goes into evaluating the laceration, then an E/M may be warranted as well as this is a new problem and an evaluation must be made by the provider.

For example, what if the provider made a judgment that the wound did not need to be closed? Is the visit free? No. We would charge an E/M. So it would stand that just because the wound requires closure does not mean we can't get paid for the work that went into making that decision. It's not bundled.

Things that would mark the significance of a separately billable E/M are: determining depth, presence of foreign bodies, exploration of the wound, and judgment on how best to close the wound (sutures, staples, dermabond, etc).

The above are payable criteria under the E/M guidelines. I'd look close at the documentation.

The only time I will not bill an E/M separately is if the visit is a return to clinic for a previously evaluated condition that warrants a procedure at a future visit. The evaluation has already been made and paid. But at some point, the evaluation happens.

 

[FLoweRS24]

E/M w/procedure by two providers

I need some guidance. My scenario is as follows: Patient presents to office for follow-up visit for a sebaceous cyst. The nurse practitioner evaluates the patient and decides an I&D is in order. The nurse practitioner approaches her supervising doctor and asks him if he would perform the I&D, which he does.

My question is: Can the nurse practitioner get credit for the follow-up visit (99213) and the supervising provider get credit for the I&D (10060)?

Any input you can give me would be greatly appreciated.

Shelly

 

[Leenahz]

I differ.

If the patient presents with a laceration, and a significant amount of work goes into evaluating the laceration, then an E/M may be warranted as well as this is a new problem and an evaluation must be made by the provider.

For example, what if the provider made a judgment that the wound did not need to be closed? Is the visit free? No. We would charge an E/M. So it would stand that just because the wound requires closure does not mean we can't get paid for the work that went into making that decision. It's not bundled.

Things that would mark the significance of a separately billable E/M are: determining depth, presence of foreign bodies, exploration of the wound, and judgment on how best to close the wound (sutures, staples, dermabond, etc).

The above are payable criteria under the E/M guidelines. I'd look close at the documentation.

The only time I will not bill an E/M separately is if the visit is a return to clinic for a previously evaluated condition that warrants a procedure at a future visit. The evaluation has already been made and paid. But at some point, the evaluation happens.

Hi Saedron,

To my knowledge, determining depth, foreign bodies, etc. does not constitute a separate E/M (which would require a modifier 25, and a modifier 25 specifically states it must be "separately identifiable.") If there are deep layers to be repaired or a single-layer that is contaminated then this would classify as intermediate repair. Wounds that are treated with adhesive strips would use an E/M.

Please direct me to your source that states an E/M visit can be charged when determining the depth, judgment on best method to repair, etc. I'm very interested to know.

Thank you for your help,
Lena