Wiki 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...
 
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.
 
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.
 
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.
 
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
 
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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