Wiki new patient/consult and procedure

[heidi engle]

Our auditing department and billing dept disagree with each other on coding this and we are stuck between ( and getting dinged on audits). When we transitioned to EMR, they sided with Billing. This is alot of revenue. As a surgical practise, when a patient is seen as consult or as a new patient and a procedure such as breast aspiration or skin lesion removal is often done at that time. May we charge a New Patient E/M and the removal or procedure code? The provider is doing a new patient exam.....

 

[swilliams2]

billing proc

Not working in a specialists office, I am answering only from what I believe to be coding knowledge, not experience in the matter.

Having said that I think it could go either way depending on the situation. If the provider was asked to evaluate and treat the patient, then they couldn't possible so a procedure without evaluating the patient first and deciding what needed to be done. In this case, I would bill the E&M with mod 25 and the procedure.

If the patient was referred for a procedure only, and your provider could do the procedure without evaluating the patient, then I would bill only the procedure.

 

[nyyankees]

Our auditing department and billing dept disagree with each other on coding this and we are stuck between ( and getting dinged on audits). When we transitioned to EMR, they sided with Billing. This is alot of revenue. As a surgical practise, when a patient is seen as consult or as a new patient and a procedure such as breast aspiration or skin lesion removal is often done at that time. May we charge a New Patient E/M and the removal or procedure code? The provider is doing a new patient exam.....

I would bill both as the doc would need to evaluate the patient before performing the procedure. Even if the patient was referred I would think that the performing doc would have a final say as to whether a procedure is warranted or not. The doc could evaluate and feel a procedure is not necessary. My two cents..

 

[kaywil2]

New Pt/Consult/ Procedure

Actually it still comes down to a separate, significantly identifiable E/M. If the physician does not perform over and above the usual presurgical eval or if the physician does not have another condition to evaluate the physician for and can stand alone from the procedure, then the E/M, even on a New PT/Consult cannot be submitted. It would warrant only the procedure be submitted.

Check with your payor to see if they handle it differently but CMS includes this in their manual. You may also check with supercoder.com. They have information on their web site.

 

[GaPeach77]

From an auditing perspective, I would hope that the provider has evaluated the new patient before jumping into a procedure therefore an E/M level can be billed with this visit, IF, and I stress IF, the provider has documented an HPI, EXAM and MDM since all three components are needed to bill for a new patient as well as a MDM is needed to determine that the patient needs a procedure done. I dinged for providers billing an E/M with a procedure, but not documenting it as well as NOT billing an E/M with the proper documentation.