Wiki New pt E/M bundled into procedures

[cmmfeyen]

I'm being told that new pt E/M codes are not bundled into procedures and therefore are always billable. I have always been taught that there is an E/M level built into the 0-10 global day minor procedures, and that it didn't matter if the patient was new or established, you don't bill for that. You only bill a separate E/M if there is another issue that's being addressed or if the first issue needs more of an examination than the usual pre- and post-op care that is bundled into it already. Any thoughts on this??

Thanks!!
Carolyn

 

[thomas7331]

You were taught correctly. Although the new patient office E&M codes are not included in the NCCI code pair edits, the guidance is clear that the same rules apply to new patient E&M services as do for established. Per the NCCI 2020 Coding Policy Manual, Chapter XI (underlining added):

In general, E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.