HELP E&M or Not

[mburke81]

My Otolaryngologist sees patients with history of cancer of the larynx, etc on an annual basis to scope them. SHould he be billing an E&M even if they do not have any symptoms??? I say yes he is reviewing. How do you handle this???

 

[jackjones62]

Remember, F/U encounters need to meet only 2 out of 3 key elements, so I am sure your Dr. takes a history, does a ROS and some sort of exam, even if limited, especially for someone returning for F/U on Laryngeal Ca.

I would be comfortable enough to say that billing an E/M and scope on these patients is appropriate if it's documented.

Jennifer
CT ENT

 

[FTessaBartels]

No E/M

If the patient is coming in specifically to have a scope, then the E/M is included in the procedure.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[Peter Davidyock]

Is the physician managing any other conditions during the visit? New or exisitng.

 

[mburke81]

These patients have history of cancer, and just come in for yearly check for reoccurence.

 

[jackjones62]

You need to treat each patient individually and go by the documentation, none of us can tell you that every one of your patient's that come in for an annual f/u and scope for history of CA should only be billed the scope; you need to review each encounter individually and base your billing on what was done or not done; I do not believe that all coding is black and white, I code using guidelines and supporting documentation; I will not code if I am unable to support and prove my decision making.

Jennifer
CT ENT

 

[mburke81]

Thought that is how it would be, but i also can see it goes by documentation. I am with you just nice to get input from others thanks.

 

[btadlock1]

My Otolaryngologist sees patients with history of cancer of the larynx, etc on an annual basis to scope them. SHould he be billing an E&M even if they do not have any symptoms??? I say yes he is reviewing. How do you handle this???

Without any current complaints, it is preventive - meaning, you couldn't bill an office/other outpatient code (99211-99215, assuming they're established), if you could bill an E/M at all. (You can't...) There are 2 things to consider, here:
1. If the patient is having a scope done, the E/M done at that encounter is included with the surgery. You'd have to show that either, there was a problem, and that it led to the decision to perform the scope right then, or that it was completely irrelevant to the scope, or the past medical history that led to the scope, or anything pertaining to the surgery taking place that day, in order to report it separately.
2. Medical necessity is defined by the frequency of services, too. It would be wise to review the coverage determinations regarding aftercare, and other relevant issues, before rendering services that may be denied, or recouped at a later date, after an audit. An annual scope exam absent any symptoms seems a bit excessive to me, but I could be wrong...