Hi all,
Evaluation of a NEW problem with procedure same day- when is an E/M appropriate?
Scenario: Patient presents for evaluation of a NEW straightforward problem (no other complaints, an otherwise healthy individual) and has procedure done for the problem same visit, such as wart destruction, skin tag removal, ear wax removal, nail removal, incision & drainage.
Question: Even though the clinician performed an evaluation, determined the diagnosis & decided to perform procedure, the problem itself is one that is necessarily to result in procedure (in other words the clinician knows just by looking at the patient's problem what the treatment option is), therefore it would only be permissible to report the procedure? Whereas it is permissible to report an E&M service when the problem being evaluated wouldn't necessarily result in procedure?
NCCI:
- "If a minor surgical procedure is performed on a NEW patient (NEW issue)...the fact that the patient is NEW is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure."
- "In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the global surgical package for the minor surgical procedure, and shall not be reported separately as an E/M service."
Thank you all, I look forward to hearing your thoughts.
Evaluation of a NEW problem with procedure same day- when is an E/M appropriate?
Scenario: Patient presents for evaluation of a NEW straightforward problem (no other complaints, an otherwise healthy individual) and has procedure done for the problem same visit, such as wart destruction, skin tag removal, ear wax removal, nail removal, incision & drainage.
Question: Even though the clinician performed an evaluation, determined the diagnosis & decided to perform procedure, the problem itself is one that is necessarily to result in procedure (in other words the clinician knows just by looking at the patient's problem what the treatment option is), therefore it would only be permissible to report the procedure? Whereas it is permissible to report an E&M service when the problem being evaluated wouldn't necessarily result in procedure?
NCCI:
- "If a minor surgical procedure is performed on a NEW patient (NEW issue)...the fact that the patient is NEW is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure."
- "In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the global surgical package for the minor surgical procedure, and shall not be reported separately as an E/M service."
Thank you all, I look forward to hearing your thoughts.