Est pt e/m with procedure


Dallas, TX
Best answers
Is it correct coding when you bill an established patient visit with a procedure? I have a doc who is questioning this practice. We have an established patient who came in for a laceration repair and he wants to know if we can charge the office visit and the laceration repair.
You can bill an E/M visit with a laceration repair provided the patient is treated for a different problem in addition to the laceration, such as hypertension. Be sure to append modifier 25 to the E/M code. Hope this helps!

Teresa Collins, CPC
I would code the E/M with -25 and the lac repair. Not only is your doc doing the repair, he/she has to evaluate the areas/systems surrounding the lac and decide what type of repair is best or if any is required.
I agree with Lisa. Also, per Medicare guidelines, "the E&M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E&M services on the same date."

Zaida, CPC
As long as you append -25 to your E&M and document a significant and seperate dx other than the laceration dx.