Wiki I&D Abscess (10060) with office visit and preventative visit

[mosmith]

Good morning everyone. I have an established pt that came in the office for a well child check, but also had a sick visit and I&D Abscess.

Can I bill the offc E/M, prevent E/M, and 10060? Would all get reimbursed as long as I have Mod 25 on the sick visit?

 

[dballard2004]

I will wager an opinion here.

If the additional E/M was significant and separately identifiable above and beyond the usual pre and postoperative work of the I & D, then you may report it with modifier 25 appended. I can't speak to reimbursement, but I would suggest talking with the payer in question here for further guidance.

I am not for certain here, but since you have two, significant, separately identifiable E/M services (the well child check and the additional office/outpatient E/M), you may need to append modifier 25 to the well child E/M as well. This may be payer specific, but I think you could have a potential problem with the payer bundling the well child E/M into the I & D.

Hope this helps and again this is my opinion.

 

[mosmith]

It does help. Thank you.