I&D and E/M

kwitts81

Contributor
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Hi so i am wondering general census, i had an encounter where there was an I&D needed i didnt see that anything else was evaluated but this. The MD billed a E/M as well a 99213, well i was thinking the E/M should be removed i double checked with a supervisor but they said to keep E/M cause the MD prescribed a antibiotic. I would think that would be a normal part of a procedure that involved a abscess of sorts, and not above and beyond. But what are your thoughts. I just wasnt feeling secure in that decision.
 

csperoni

True Blue
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Selden
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When I am unsure about whether or not an E/M justifies it's own billing (either with a procedure, or potential global surgery), I cross out everything related to the procedure or postop. Is what is leftover enough to justify an E/M? Prescribing a medication after the procedure does not necessarily justify an E/M.
It sounds like in your case, the answer might be no, but there are situations where the answer could be yes.
I like the Novitas info on modifier -25 https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00153948
 

Orthocoderpgu

True Blue
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Salt Lake City, UT
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Great advice Christine! Something else to keep in mind is that every surgical procedure, yes even a lowly I&D has a "built in" E/M component to it. Was the decision to perform this procedure made during this visit? If yes, it could be supported. If the decision was already made...
 

kimberlywatson

Networker
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Brentwood, TN
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When I am unsure about whether or not an E/M justifies it's own billing (either with a procedure, or potential global surgery), I cross out everything related to the procedure or postop. Is what is leftover enough to justify an E/M? Prescribing a medication after the procedure does not necessarily justify an E/M.
It sounds like in your case, the answer might be no, but there are situations where the answer could be yes.
I like the Novitas info on modifier -25 https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00153948
I like this approach, but I'd be careful to immediately cross out everything related to the procedure or postop. As the Novitas link says, sometimes an E/M is warranted if the treatment goes above and beyond what would normally be done during the pre/postop period - - meaning it may still be related. I only say this because I've made this mistake in the past! But again, I overall agree with your approach and it's helpful.
 
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