RCiscoObGyn
New
- Messages
- 4
- Location
- Russell, KY
Hey everyone,
I'm looking for some input from more experienced OB/GYN coders on this scenario that's been driving me bonkers. I'm very comfortable with using mod 25, but this particular situation always gets me arguing with myself and ready to chuck my computer out the window. I'd really like to hear how others interpret it.
Scenario: Pt presents for a routine GYN prev visit. During the exam, the provider palpates a breast lump, documents additional history related to the lump, performs a more targeted breast exam, switches mammogram from screening to diagnostic and/or orders ultrasound.
Question: Would you consider this a separately billable problem-oriented E/M-25, or do you treat all findings during a prev exam as incidental and part of the prev service? I'm specifically wondering how others draw the line between incidental finding vs. new problem discovered, evaluated, and managed during the prev. I realize something like N93.9 that is additionally evaluated and managed during the prev exam would clearly be separately identifiable and able to stand alone. While I'm coding prev clinics, I always ask myself, "If this were by itself in a separate note, could it stand alone as a billable E/M?", but this particular situation, and ones like it, feel eerily blurry. I'd really appreciate hearing how you all treat this situation during coding and/or auditing.
I'm looking for some input from more experienced OB/GYN coders on this scenario that's been driving me bonkers. I'm very comfortable with using mod 25, but this particular situation always gets me arguing with myself and ready to chuck my computer out the window. I'd really like to hear how others interpret it.
Scenario: Pt presents for a routine GYN prev visit. During the exam, the provider palpates a breast lump, documents additional history related to the lump, performs a more targeted breast exam, switches mammogram from screening to diagnostic and/or orders ultrasound.
Question: Would you consider this a separately billable problem-oriented E/M-25, or do you treat all findings during a prev exam as incidental and part of the prev service? I'm specifically wondering how others draw the line between incidental finding vs. new problem discovered, evaluated, and managed during the prev. I realize something like N93.9 that is additionally evaluated and managed during the prev exam would clearly be separately identifiable and able to stand alone. While I'm coding prev clinics, I always ask myself, "If this were by itself in a separate note, could it stand alone as a billable E/M?", but this particular situation, and ones like it, feel eerily blurry. I'd really appreciate hearing how you all treat this situation during coding and/or auditing.