Wiki Office visit and epistaxis control billable together?

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wynonna

True Blue
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Hinsdale, MA
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Hi fellow coders:
A patient was referred to us from ER with epistaxis. He came to our ENT office for cautery for epistaxis and MD prescribed a new Rx. for epistaxis.
Can we bill 99204 with 30901 for cautery with modifier 25?
thank you
 
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Hi there, I'm not seeing a significant, separately identifiable E/M visit in this scenario
 
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wynonna said:
Hi fellow coders:
A patient was referred to us from ER with epistaxis. He came to our ENT office for cautery for epistaxis and MD prescribed a new Rx. for epistaxis.
Can we bill 99204 with 30901 for cautery with modifier 25?
thank you
Click to expand...
the reason for the encounter is the cautery therefore, append modifier 25 would not be appropriate.
 
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It would depend on the content of the Evaluation and Management. You do not need a separate diagnosis to have the E/M stand alone. Your provider needs to have documentation that goes above and beyond the inherent E/M components of just the procedure. This would be best settled with a review of the note with your provider's input. If you have a note were just cautery was billed in the past to compare your current note to, that may be a good place to start the conversation with your provider.
 
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Yes, and thank you. MD did a comprehensive exam and detailed History in order to determine which procedure had to be done. He also had to look at ER notes and tests and procedures done there and re-evaluate RX started by ER and response to treatment.
 
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