Wiki Infertility

Bellevue, NE
Best answers
I am looking for other infertility coders to network with! If you know of any willing to network, please share! Thank you for your assistance!!!!
Infertility question

I am an auditor and working on an Infertility specialist.

When a patient is on Clomid, at some point in the cycle she will need to come in every day or so to monitor the follicle 'readiness'. Doc bills the correct code, 76857. However, she also bills a 99213-25 each and every time. She claims it's the 'counseling' but the note basically states either come back in 2 days, or 'inject xyz daily, or 'retrieval scheduled for mm/dd/yy. To me, all of these things should be included as the post-work of the test. She notes an exam, but I doubt that she is doing one each time, it's a template. Even if she was doing a very limited pelvic exam, I still don't see billing an E/M for a pre-scheduled ultrasound every other day. Thoughts? tx.
No E/M with Follicle Monitoring

Thank you so much for your response. I'm going to have a hard time convincing this particular physician. Do you have documentation from ASRM that I could show her? I don't have access to that site, would need to be a member. Anything you can send would be appreciated.
e/m description

Guidelines on billing an E+M code along with office procedures (e.g. HSG, IUI, pelvic ultrasound):
E+M services on the same day as office procedures should be reported only if the patient’s condition requires a significant, separately identifiable evaluation and management service. That E/M service should be above and beyond the usual pre- and post-procedural care.