Sick / well same date

williafm

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Help. Disagreement with co coder .
I have an np that did a well woman and found a lump in the pt breast. She ordered an us . I have no hpi as there was no complaint. I have no exam above the normal breast exam. All i have is mdm of moderate for new prob with work up. I say sick visit isnt billable because there is only 1 of 3 not 2 of 3. My co coder says she can bill the sick because she's doing additional work up.
 

cdeak01

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I believe you have answered your own question. Since the doctor did not meet the requirements for the key components (2 out of 3) a separate E/M service would not be billable. I agree with your coworker that it is a new problem with additional workup however the provider would have needed to document an HPI.
 

williafm

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i believe you have answered your own question. Since the doctor did not meet the requirements for the key components (2 out of 3) a separate e/m service would not be billable. I agree with your coworker that it is a new problem with additional workup however the provider would have needed to document an hpi.
thank you
 
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