nlbarnes
Expert
AAPC had in one of the issues of Healthcare Business Monthly this statement:
However, a significant and separately identifiable E & M service unrelated to the decision to perform the minor surgical procedure is separately reportabe with modifier 25. The E & M service & minor surgical procedure do not require different diagnoses.
This seems conflicting to me in that "if the E & M service unrelated to the decision to perform the minor surgical procedure... a different diagnoses isn't required".
How would the diagnoses pertaining to the procedure substantiate the E & M if what the other guidelines state the patient needs to have another problem other than the procedure. For example, patient comes in for aspiration of the knee. Then he says, oh by the way, I have an ear ache. I get how an E & M is separately billable along with the procedure.
I have the guidelines & tons of articles and I will never feel comfortable with this.
However, a significant and separately identifiable E & M service unrelated to the decision to perform the minor surgical procedure is separately reportabe with modifier 25. The E & M service & minor surgical procedure do not require different diagnoses.
This seems conflicting to me in that "if the E & M service unrelated to the decision to perform the minor surgical procedure... a different diagnoses isn't required".
How would the diagnoses pertaining to the procedure substantiate the E & M if what the other guidelines state the patient needs to have another problem other than the procedure. For example, patient comes in for aspiration of the knee. Then he says, oh by the way, I have an ear ache. I get how an E & M is separately billable along with the procedure.
I have the guidelines & tons of articles and I will never feel comfortable with this.