Wound care clinic, E&M-25 and wound care...is this acceptable?

Dminman

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My apologies if I've posted this in the wrong forum.

Our providers are beginning to see patients in a wound care center (POS 19). We do not own the center, simply providing the care for the patients. In the office, we do not bill for the E&M if the patient has a debridement on the same day as the visit even if they are a new patient. Does this hold true for a wound care clinic? Is it okay to bill the E&M with a 25 modifier (initial or subsequent)? Any help would be appreciated...
 

CodingKing

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Place of service doesn't change how you report these professional services. The only difference is for Medicare and those who base off Medicare, you would be paid off a facility rate instead of the Office/Non facility rate.
 

Dminman

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I'm sorry, my question wasn't clear. Am I right with the premise that we are not supposed to bill for a wound care and an E&M in the same visit unless there was a separately identifiable service for the E&M? And doesn't this rule apply to place of service 19 like it does in the office. I know we can bill the E&M in the hospital setting when doing a debridement, but not in the office. Thanks so much.
 

kdlepek

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Debridement

No, you would not bill for E/M services with debridement. Especially for 97598 and 97597. As evaluation and management services of the wound are considered included with these services.
 
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Cpc

If our MD doesn't debride the patient . We do charge an office visit for the patient. 1 charge for facility and 1 for the MD and we are getting paid when it is filed that way. If he does do a debridement on established patient then we just charge for debridement unless the patient is new. We then charge for new patient E&M with debridement codes and moldier 25
 

Pam Brooks

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If our MD doesn't debride the patient . We do charge an office visit for the patient. 1 charge for facility and 1 for the MD and we are getting paid when it is filed that way. If he does do a debridement on established patient then we just charge for debridement unless the patient is new. We then charge for new patient E&M with debridement codes and moldier 25[/QUOTE

You cannot bill an E&M with a minor procedure just because the patient is new. Per CCI edits 1/1/2016:

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is "new" to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.







 
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