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office visit E/M code on suture visit

C

CODE.REBECCA.DEWICK

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15
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Independence, MO
My provider (derm) biopsied a rash. On the suture visit had discussion regarding the results of that biopsy and went over treatment options, ultimately deciding to try a script oral/topical as best treatment option. I discussed not charging office visit E/M code but provider feels rash pathology discussion involves enough information and discussion that charging E/M code is appropriate. All pertinent information is in note such as HPI & MDM. Thoughts??
Rebecca
 
tough one....

It was always my understanding that anything having to do with the original procedure, i.e. reviewing pathology or suture removal, is considered part of the procedure and therefore is "global". If the patient was seen for another condition, then an E&M code could be billed with a modifier for the post-op period.

Hope this helps.
Brandi S.
 
Definitely a grey area. Per CMS, "Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not included in the global period; I would let the doctor make the decision on whether or not this visit falls under the "Normal recovery from surgery".

See attached link for reference.

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf
 
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Most skin biopsies don't have a global period. If that's the case for the procedure that was originally billed, I don't see any reason why you would not want to bill for the follow-up service, unless it was simply done as a courtesy for the patient.
 
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