Best answers
Note: The following project was submitted by a non-member. This thread has been left open so you can reply to it. If you believe you are qualified and wish to be contacted, please post your contact details so the non-member may get in touch with you.

Project Description:
We opened a vascular access center and I have an E&M question. Our docs do a complete evaluation and management of the patient to make the determination on whether to perform the surgery or not. The nephrologist surgically creates the AV graft and our docs manage the patient's graft. The patient's go to have dialysis and the patient cannot be dialized that day due to a malfunction of graft. The nurse from the dialysis center calls our vascular center and sets up an appt for our docs to evaluate the graft. Depending on the full exam etc...and looking at the graft determines whether the docs do interventional means or send them back for surgical interventiona to their PCP. My question is if our docs are taking over complete care or assuming responsibility of the graft and treatment of the patient can we bill that E&M prior to the intervention? Our docs do a full blown E&M with good documentation.

Thanks in advance for all your help.
Vascular Access Center question

Are your doctors employed by the dialysis center? When they are conducting this full-blown E & M, what other organ systems or body areas are they examining? Wouldn't their examination be strictly related to the AV graft and presenting problem? I think you would be shortchanging yourself if you try to bill an additional E & M prior to the intervention. Global days would factor significantly in the processing of your claim, as would appropriate modifier usage.

It has been my experience that AV graft failure tends to compound over time, necessitating numerous returns during the global period. You would have to append modifier -25 to the E & M if done the same day as the intervention. Check your RVUs and be careful to list the major procedure first, as additional procedures will most likely be reduced, if paid at all.

Patricia Hayes, MBA, CPC, CMM, CHCC