PT/INR and E/M with modifier 25 in Long term care

[jbrannon109]

It has been my understanding that billing an PT (85610) is only for the PT itself and not for the adjustment of the dosage of the medication. Since I work in long term care I have the question on if a low level E/M visit (99307) can be billed with a 25 modifier with a (85610) if an adjustment occurs. However, with the 25 modifier I am hesitant to proceed as the 99307 doesn't really stand alone without the 85610. Could anyone please shed some light on this scenario for me? I appreciate all your cooperation. I've been billing a while now and for some reason I keep asking this same question over and over and would really like to be compliant. Any Medicare guideline or helpful tips for Medicare I would also appreciate. I already receive the email listings but when I go out to the CMS website I get lost....to this day.
Thank you in advance,
Jen

 

[thomas7331]

You're correct in that the 85610 is for the test only. Labs don't have an E&M component, so any evaluation and management of the patient, including adjustment of the dosage, would be a component of an E&M code, if the documentation requirements are met (modifier 25 is not required for most payers because the E&M should not bundle to a lab charge). In a facility location though, you cannot bill physician services under 'incident to' rules as you could for a nurse visit in the office, so a dosage adjustment alone would not qualify for an E&M charge - the provider would need to see the patient and there would have to be documentation of a face-to-face encounter with the required elements in order to bill an E&M code.