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E/M with office procedure question?

  1. Question E/M with office procedure question?
    Medical Coding Books
    Hello, I was wondering if someome can help me with a reoccuring question that I have been encountering. If an established patient comes in for an OV with the physician, for a complaint of pain or a complaint of suspicious lesion and we perform an office procedure like bursa injection or shave biopsy, can we bill for the E/M service and the procedure? I appreciate everyones help!

  2. #2
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    It depends on whether the patient came in with the intention of having the lesion removed or joint injection. If they came in for an office visit and decided at that time, then the separate and identifiable E/M should have a 25 modifier and code for the removal. If they were scheduled with the intention of having the lesion removed or joint injection, the E/M portion is inclusive to the procedure and you would use the removal/injection only.

    Good luck
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  3. #3
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    I agree, just make sure you have 2 separate diagnosis, and bill the office visit with the mod 25. You should get pd for both.
    Kristen Richard, CPC

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    The patient came in with the complaint and the decision was made at the time of service to do the injection/ biopsy. The patient wasn't scheduled to have a procedure.

  5. #5
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    Thats good, but you still need to bill the o.v. with a separate diag. So if the patient came in with pain, then bill the pain diag with your o.v. and bill the lesion by site for your procedure.
    Kristen Richard, CPC

  6. #6
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    Two different diagnoses are NOT required. I am attempting to locate the documentation for this. I will post it when I find it.
    Walker Bachman, CPC, CPPM

  7. #7
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    Walker Bachman, CPC, CPPM

  8. #8
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    I thought that was your question????? I have always been paid for both E/M and procedure with 2 different diagnosis. I did NOT say that it was required. It is only the way to bill to get both procedures paid.
    Kristen Richard, CPC

  9. #9
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    Quote Originally Posted by krssy70 View Post
    Thats good, but you still need to bill the o.v. with a separate diag. So if the patient came in with pain, then bill the pain diag with your o.v. and bill the lesion by site for your procedure.
    This statement sounded to me like you were saying that the office visit must have a different dx from the procedure. I didn't mean to offend..
    Walker Bachman, CPC, CPPM

  10. #10
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    Quote Originally Posted by krssy70 View Post
    I thought that was your question????? I have always been paid for both E/M and procedure with 2 different diagnosis. I did NOT say that it was required. It is only the way to bill to get both procedures paid.
    The OP was asking about a procedure billed along with an office visit. I don't know what you mean when you say "both procedures".
    Walker Bachman, CPC, CPPM

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