EM's with Procedures

[arkolab]

Looking for input on if other facilities are billing EM's with procedures when the provider does an independent interpretation or review of an x-ray, ultrasound, CT, MRI in conjunction with the procedure on the same day. We have some auditors saying that it would be included in the procedure as reviewing/interpretating the image leads to the plan of care while other auditors are saying that would be separately billable.

 

[jkyles]

Hi, could you give some more detail? If the patient came in with a complaint like knee pain and the provider decides to perform a procedure after a full E/M visit (that included image interp), then that could support a separate E/M. But if the patient came in for a procedure and the provider just looks at some images as a final check before the procedure, that's not an E/M visit.

 

[amyjph]

It depends on the documentation and the specifics of the encounter. Do you have an example? If billing a code where the code description includes interpretation and report for example, the provider does not then get an additional E/M for interpreting or the report. When you say facilities, are you talking about pro fee/outpatient coding or facility coding?
If in the office setting, if documentation meets the requirements to report an E/M, and there was an XR ordered and performed in house and provider did the interp. they get credit for the E/M and bill the 7XXXX code separately. But it does not sound like that's what you are asking about. We are a little confused about the specifics of the question.
Are you asking about things like US & CT guided injections, etc.? As in, 76942, 77012 or 20611? They don't get a separate E/M for that. If anyone is saying that it is a bit off track.