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scopes w/ new pt visit

  1. #1
    Default scopes w/ new pt visit
    Medical Coding Books
    We have an ENT doc that scopes every new pt that walks in the door. Can you bill for both the scope and the new pt visit with a -25?
    I dont think that he should get both b/c it's not significant or separately identifiable/nor is it above and beyond the normal scope for him, however, my boss doesn't agree.

    I would appreciate any feedback.
    Malama pono,

    Sundae Yomes

  2. #2
    If your ENT provider is only documenting the scope procedure, then you are correct no New Patient Visit should be billed in addition to.

    However, if the ENT provider is documenting ALL 3 components of a New Patient Visit: History, Exam & Medical Decision Making, AND the scope procedure, you may bill for both. Don't forget the 25 modifier on the E/M.

    Documentation is key, especially the medical decision making!
    E. Frohna
    Evangelina Frohna, CPC, CEMC

  3. #3
    Stuart Sailfish Chapter
    Evangalina is correct, if an E/M eval is being performed with all the bullets documented and a scope is performed 992xx -25 and the scope.
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA

    "Nothing is stronger than the heart of a volunteer"

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