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E/M with office procedure question?

  1. #11
    Medical Coding Books
    I meant by stating both procedures was the E/M and surgical procedure. You did not offend me, I was just clarifying that I did not mean that it was required. It is just my opinion in my years of billing E/M, that I always use a different diag, and always have been paid. I was only trying to help, the intial person who posted this question, to get her claim paid. Sometimes you cannot bill it with a different diagnosis, and you are forced to bill it with the same diag, in hopes that it will pay, and if not, you only bill the procedure. The modifier 25 have always been interperted different by the majority of coders.
    Kristen Richard, CPC

  2. #12
    Well put!

  3. Default
    I feel I owe an apology for my poorly worded question. I should have used a single example. A patient comes in with a complaint of elbow pain. Apon evaluation it was determined the patient has lateral epicondilitis and an injection of the elbow was done. Can an E/M and a procedure be billed? The patient wasn't scheduled for an injection.
    Sorry for the confusion. I am still a student and working with coding at the same time!
    Kelly G.

  4. #14
    Kelly, I would only code the procedure code, since that is the only thing being treated and that is why the patient came in in the first place. He came in for the elbow pain and the physician treated it with an injection. Now if the patients knee was also sore and the doc looked at that and did an exam, then you could code an E&M along with -25. Does that help?

    Never appologize! This is how we all get better at this

  5. Default
    Yes! That helps me alot. I really appreciate the input. :0) Kelly

  6. #16
    My pleasure!! Half of everything I know, I learned in these forums. They can be super helpful!!

  7. #17
    Thats right Kelly, Well said by Ltibbets...Thank you Ltib...

    In the future Kelly, if your pt is being seen for a completely different diag, and in the same visit, brings up an issue where the physician decides (in that visit) that it needs to be addressed, (with an injection/excision) then most definetly you can bill both the E/M and procedure with the 2 different diag and the mod 25. Sometimes us fellow coders have to disagree to agree..

    Good luck
    Kristen Richard, CPC

  8. #18
    I apologize for misunderstanding your posts. My only point was that 2 different diagnoses are not required when billing a procedure and an office visit on the same DOS, which is what I thought you were saying. Certainly you can use two different diagnoses if they are appropriate.
    Walker Bachman, CPC, CPPM

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