Wiki Medical Decision Making

[AprilSueMadison]

I hope I explain this well enough for it to make sense....

A patient comes in with a lesion that needs to be biopsied. We do the work included in the biopsy and only bill out a biopsy as nothing above and beyond that work occurred. So no OV is billed out.

NOW, we have a lesion and a rash. We do a workup and I have an OV exam and a biopsy of 11100.

Per Medicare guidelines, the biopsy is a minor surgical procedure so I'm getting the office visit from everything related to the rash (What the AAD tells us to do is cross everything off related to the biopsy and if we still have an OV then we bill for one).

BUT...I would technically cross out medical decision making for the biopsy as well. Does the biopsy get considered in medical decision making though for the entire visit?

In diagnostic procedures ordered, one of the examples is skin biopsies.

I hope this makes sense. Thank you for your help!

 

[a.montaruli@gmail.com]

Hey April,

From my experience auditing, I would not count any elements from any of the E/M componenets (H,E,MDM) related to the biopsy. You are correct in saying that within the one note, you should have 2 separate an identifiable history, exam and mdm components related to two separate diagnoses.

In this case, depending on the severity of the rash, I may code a 99212 since a rash in itself is considered a self-limited problem. Remember even a straight forward MDM is still considered an MDM.

You do run the risk of a low level office visit being denied but using the correct diagnoses, an appeal would be appropriate.

Hope this helps,
Andrew

 

[AprilSueMadison]

Actually it does, thank you very much!

Currently I'm using the E/M Interactive Tool on First Coast Service Options website for help and I wanted to be sure I'm calculating correctly.