Wiki Unrelated E/M with procedure

[nittamarable]

Hi, general question... Is it appropriate to bill an E/M -25 when its unrelated to the primary procedure on every visit? It's not bundled due to both codes being unrelated. For example, patient comes in for debridement 11042 on right ankle, but provider treats edema in another area which is new. For every following visit, can we bill the E/M -25 for the edema & debridement for followup visits? Or is the E/M billed once - during the visit it was first discovered?

 

[carlystur]

I'm decently sure that, once discovered, the follow up exams would be included in the procedures for following visits where the exam is only relevant to the procedure itself.

 

[csperoni]

If the provider is actively TREATING the edema every visit (prescribing or adjusting medication, evaluating progression/improvement), then the E/M with -25 is appropriate.
If the provider just says "hey, keep an eye on your edema" as they are debriding the ankle, then I would not code it separately.

 

[podcoder70]

Wound coder here, I disagree with carlystur and agree with csperoni. Only Bill the e&m on subsequent visits if the document clearly states what the provider did to treat the edema at each subsequent visit. Just stating the patient has it does not a treatment make.

 

[carlystur]

My apologies. I likely did not have had a good understanding of the issue here when I wrote that. Here is an AAPC post on Modifer 25 use: Not All E/M Services Are Billable

 

[nittamarable]

I appreciate everyone's help!