Wiki Procedure alone or E/M and procedure?

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Bernadette10

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Since the provider discussed the procedure before doing it, is this enough to bill a separate 99213? I was thinking no, that it should just be 17000, but I'm doubting myself. I know a similar question has been asked before, but it's still a hard decision.

Patient presents for a new spot on the LT clavicle.

Past Medical History:
Actinic keratoses.
Basal cell carcinoma.
Disease of thyroid gland.

Review of Systems:
General: No fever or chills
Skin: No new rash

Chart reviewed including PMH, social history, family history, allergies, and current medications.

Exam:
General: well developed, well nourished, in no acute distress.
Mood: Pleasant:
Mental Status: Alert and oriented.

Assessment:
AK left clavicle. After a discussion of the procedure, the lesion was treated with liquid nitrogen x2. Patient tolerated well.

https://www.aapc.com/blog/27690-know-when-to-bill-em-with-a-minor-procedure/​

The Visit’s Purpose Can Help You Decide​

Even if the E/M service is related to the minor procedure, you still may be able to report it separately. Ask yourself: Did the E/M occur because of the procedure, or was the need to perform a minor procedure determined as a result of a significant (i.e., fully supported by documentation and includes the key elements of history, exam, and medical decision making (MDM)) E/M service? Only in the second case may you report the E/M in addition to the procedure.

The Medicare Claims Processing Manual, Chapter 12, Section 40.1.c, explains:

A visit on the same day could be properly billed in addition to suturing a scalp wound if a full neurological examination is made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status.
 
I would not consider an E&M -25 appropriate here. Remember -25 means significant and separately identifiable.
Whenever I am on the fence about whether to bill an E&M -25, I take the note and cross out everything that was related to the procedure. That gives me the separately identifiable. Is what is left significant? If not, then don't bill E&M. In your situation, I don't see a significant E&M service determining the need for the procedure, or any other problem addressed.
 
Bernadette10 said:
Since the provider discussed the procedure before doing it, is this enough to bill a separate 99213? I was thinking no, that it should just be 17000, but I'm doubting myself. I know a similar question has been asked before, but it's still a hard decision.

Patient presents for a new spot on the LT clavicle.

Past Medical History:
Actinic keratoses.
Basal cell carcinoma.
Disease of thyroid gland.

Review of Systems:
General: No fever or chills
Skin: No new rash

Chart reviewed including PMH, social history, family history, allergies, and current medications.

Exam:
General: well developed, well nourished, in no acute distress.
Mood: Pleasant:
Mental Status: Alert and oriented.

Assessment:
AK left clavicle. After a discussion of the procedure, the lesion was treated with liquid nitrogen x2. Patient tolerated well.

https://www.aapc.com/blog/27690-know-when-to-bill-em-with-a-minor-procedure/​

The Visit’s Purpose Can Help You Decide​

Even if the E/M service is related to the minor procedure, you still may be able to report it separately. Ask yourself: Did the E/M occur because of the procedure, or was the need to perform a minor procedure determined as a result of a significant (i.e., fully supported by documentation and includes the key elements of history, exam, and medical decision making (MDM)) E/M service? Only in the second case may you report the E/M in addition to the procedure.

The Medicare Claims Processing Manual, Chapter 12, Section 40.1.c, explains:

A visit on the same day could be properly billed in addition to suturing a scalp wound if a full neurological examination is made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status.
Click to expand...
Billing Rule..if the patient had a prior visit and at that visit the physician concluded that the patient needed a procedure but the patient did not have the procedure at the initial visit but elected to schedule on a different day; when the patient comes back to see that doctor and the only reason for that visit is to perform the procedure discussed at the last visit then the procedure is the only thing billable at that second visit. However if at that 2nd visit the patient presents with a new problem or an existing problem worsening unrelated to the procedure thats about to be perfomed and the doctor treats those issues, then an EM code with a 24 modifier can be billed in addition to the cpt thats being performed.
 
I agree with the responses above. there is not enough to support an E/M with the procedure (based on the info provided).
 
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