Wiki Office visit E/M using MOD -25

[KaitlynEFitch]

My boss just threw me in for a huge curveball, and I haven't been coding for long.

I thought I knew about E/M codes, but I was wrong. My question...
How do I know when I can code for a separate E/M when a small procedure is performed in office? (Injection for itching, light treatment for acne, etc)?

Are E/M services only bundled with procedures with global days of 10 or 90? How do I know?
Thank you

 

[AprilSueMadison]

For Medicare,

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Open the file that says "NCCI Policy Manual for Medicare Services - Effective January 1, 2014" and read the PDF's there.

CHAP3-CPTcodes10000-19999_final10312013.doc

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. 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 should 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.

I've posted the above example recently and it was helpful for me.