AAPC - Back to school
Results 1 to 2 of 2

Thread: CPT code 95251

  1. #1

    Default CPT code 95251

    AAPC: Back to School
    CPT code 95251 ACGM - interpretation and report.

    I have a physician that wants to also bill for a E&M visit to give the results to the patient. I explained to him that in order to bill an office visit (99212-99215) separate from the interpretation, he would need to document what was discussed and the changes he made to the patient's medical regimen based on what he interpreted.

    He would not be able to bill an office visit to just give the results of the test, because he was already being reimbursed for the interpretation.

    Of course I am in the dog house..Opinions?



  2. #2
    Join Date
    Apr 2007
    Kingsport, TN


    Look at the instructions in parenthesis at the end of codes 95250 and 95251. They both state, "Do not report ... in conjunction with 99091. If you look at the use of code 99091, it states, "Code 99091 should be reported no more than once in a 30-day period to include the physician or health care provider time involved with data accession, review and interpretation, modification of care plan as necessary (including communication to patient and/or caregiver), and associated documentation.

    It appears that unless an evaluation and management service was performed, it cannot be billed, and, codes 99250 and 99251 already include the time he spent communicating the results to the patient. I don't think an E & M is appropriate for this situation. That's just my opinion.

Similar Threads

  1. 95251-Can it be billed by a CDE?
    By rgunwall in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 07-16-2013, 03:17 PM
  2. Overread CPT code 76140 vs Original CPT code
    By nperry@umc.edu in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 06-23-2011, 07:19 AM
  3. another 95251 question -- different from below
    By smros in forum Internal Medicine
    Replies: 0
    Last Post: 04-15-2011, 12:04 PM
  4. 95251
    By efuhrmann in forum Internal Medicine
    Replies: 1
    Last Post: 04-13-2011, 09:54 AM
  5. 95250,95251
    By bkreed in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 03-24-2009, 06:20 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.