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Minor surgical procedure and E/M

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5
Location
Fort Wayne, IN
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Looking for coding opinions:
I have advised a doctor that when a patient presents for a wart removal, it is not appropriate to code/bill 99212-25 with 17110. There is not a significant, separately identifiable service to support using the 25 modifier.
Then he asks me this:
"What if I evaluate but then schedule the minor procedure for a different day? Then is the E/M service separately billable?"

I am thinking this would not be appropriate as a way to get reimbursed for the E/M which is included in the minor surgical procedure.

I would greatly appreciate others' coding opinions.
Thanks in advance!
Rebecca Johnson, CPC
 

erjones147

Expert
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385
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My opinion is that splitting the services would be OK

One scenario I can think of is the doc see a walk-in at 4:45 for foot pain and sees a wart which can easily be removed, but there is no time to get the tray or the liquid nitrogen ready, so the patient is rescheduled for 10 a.m. the next morning

I also would like to hear from other coders who work through more minor surgeries than I see
 

thomas7331

True Blue
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I would agree with the first post (and disagree with the previous post) that scheduling the procedure for another day in order to bill the E&M is not appropriate. The work of the initial evaluation and decision to perform a minor surgery is included in the value that is assigned to that procedure. Whether it is 'unbundled' by using a modifier on the same day or by scheduling it on a different day is irrelevant since both of these are inappropriate ways to try to bypass payer reimbursement policy to get additional payment . Also keep in mind that the standard definition of medical necessity is that the services are required for reasons other than the "convenience of the patient or provider". If the only reason the patient is rescheduled is because of time constraints in the provider's schedule, or to get a higher payment for the provider, then it would not qualify as a medical necessary reason for a separate service.
 
Last edited:

CodingKing

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This was added to the NCCI manual, in 2017 i believe

Physicians shall not inconvenience beneficiaries nor increase risks to beneficiaries by performing services on different dates of service to avoid MUE or NCCI PTP edits
 
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