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Wiki New Bundling rule

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jmessick

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Effective 7-01-2013 E/M codes are being bundled with procedures with 00-10 day global! Does anyone have any thoughts or direct links that possible would help with determining if E/M would be justified if our patients expect a full body exam due to history of skin cancer. I can't imagine if our doctors do this and feel the need to do a procedure we are not able to bill for an E/M.

Thanks
 
Our understanding is that you ignore all examination/evaluation that leads up to the biopsy or cryosurgery, and then see if there is a medically necessary E/M documented for another diagnosis. We are trying the V10.82/V10.83 for personal hx of skin cancer/melanoma but unless there is a another bonifide diagnosis with appropriate HPI, exam, MDM etc then no E/M is going to be allowed. It's quite shocking, but true. The exam and MDM etc to determine that a biopsy of a lesion is needed during the course of a full skin exam is now included in the biopsy code (and other 10 day global period codes).
 
Thanks, After talking to a member of AAD this is correct. I would like to add because I can pick our notes in so many different ways.
What would you do if a new patient comes in with rash. Examed multiple body areas gave a prescription along with doing a biopsy to diagnosis rash. Would you bill E/M?
 
I read through these articles from AAD and found them extremely helpful. I love how simple it is put " One should subtract the entire E/M component included in a given procedure's valuation and then see what amount of E/M service is left. If nothing is left, then a separate E/M billing is inappropriate. The amount of what is left “stands alone” and is used to determine the level of E/M service to be billed with the 25 modifier. "


http://www.aad.org/dw/monthly/2013/june/to-25-or-not-part-one#.UfEoOG1nJkc
and
http://www.aad.org/dw/monthly/2013/july/to-25-or-not-part-two#allpages
 
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