Wiki Ethical question

[BrendaM123]

Hi!
I am fairly new to billing and wondering if it is ethical to bill an office visit when a patient comes in solely for destruction of benign lesions, 17110 or 17111. Scenario: Patient comes in as a fu for COPD. During the visit a decision regarding benign lesions that are bothering patient came up. The decision is made that destruction of 6 benign lesions be removed in a week. We get a prior authorization for CPT Code 17110 from their commercial insurance. The patient comes back for the destruction. Do we bill an E & M code along with 17110 or just 17110? We know the E&M will be an adjustment but are concerned that it may not be ethical for it to appear on the claim at all.

Thank you for your help!
Brenda

 

[AmandaBriggs]

Typically, an E/M done on the same day as a minor procedure bundles with the procedure and is not separately payable. Here is a link to the CMS Global Surgery booklet which may help:
https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

 

[zoinks071]

I agree with Amanda. Especially when the patient is coming in for a planned procedure, if there are no other problems or issues addressed at the encounter there is no rationale to report a separate E&M service. Even though you are aware of the fact that it will likely be adjusted by the payer, it could still be considered an attempt to receive an improper payment. I would not recommend it unless you had clear documentation of a separate & distinct assessment & plan apart from the destruction. Hope this helps.

 

[pattilebeau]

I would not bill an EM when the visit was exclusively scheduled for a procedure.

 

[BrendaM123]

Thank you so much for your help!

 

[dmunoz781]

If on the day pt came in for COPD and brought up the lesions, and on that same day the MD chooses to treat lesions then you can bill both just append a modifier 25 to the E/M. However much like everyone else has stated in your scenario since they left the first day and came back for a planned procedure where nothing else but the destruction of the lesions was done then only the destruction is billable and not the E/M. The E/M in this case is not separate and identifiable from the px.