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E/M coding

  1. Default E/M coding
    Medical Coding Books
    How would you code a consult billed the same day as a procedure e.g. 19100, breast bx, when the entire consult is related to the breast mass? Do you just bill for the procedure and not the E/M? Can't really use modifier 25 as it is not a significantly separately identifiable E/M. What do you do with the consult? Thanks Kathy

  2. #2
    Location
    Duluth, Minnesota
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    1,133
    Default
    so, did the patient come in specifically for the biopsy? Or did she come in for a consult (which was done) and it was then decided to do a biopsy?... to me, I'd have to assume that documentation WOULD support the separately identifiable E/M (consult) code... which would then need a .25 modifier on it due to the procedure also performed. The "two", (E/M and procedure) do not have to be different issues... it simply has to be separately identifiable -
    Since we don't have the note to review, I can't be certain - but my guess is both would be supported.
    IF the patient came in for the procedure, and the doctor did a brief exam (usual care associated with the procedure)...then, that would be a procedure only.

    again, I'm flying half blind here without the note.

    Read the definition of modifier .25 again...you'll see what I mean...
    Donna, CPC, CPC-H

  3. Default E/M coding
    she actually had a breast abscess I & D prior to this visit. She game in for a dressing change and the provider decided to do a bx to r/o inflammatory breast cancer. KP

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    so, this isn't/wasn't really a consult - it was a follow up for the I & D?
    well, again - IF the documentation supports a level of service (exam) that is beyond the "norm" for that procedure -then it can be coded...(but if it falls within a global period, you'll need other modifiers too)
    Donna, CPC, CPC-H

  5. Default e/M coding
    thanks for you feedback. Kathy

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default Without the note ...
    Guessing based on info provided since we don't have the notes.

    Patient has I&D and some days later comes for follow-up visit and dressing change, at which time physician decides to do Bx to R/O inflammatory breast cancer. I'm assuming the same physician did the I&D as is now doing the biopsy.

    I'd code the biopsy with a -78 and would NOT code the E/M visit.

    But again, like Donna, I'm flying blind without the actual documentation.

    F Tessa Bartels, CPC, CEMC

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