New Patient E/M and Procedure
I consider myself to be a pretty astute coder, but I have a coding issue that I need the help of my fellow coders, please....
I am aware that when a patient presents for a minor surgical procedure with a global period of 0 - 10 days an E/M is generally not reported because the E/M is considered inherent to the procedure unless the E/M is significant or separately identifiable. What about a new patient? When I attended the AAPC conference in June, one of the presenters stated that the CPT guidelines state you can bill an E/M with a procedure if the patient is new with modifier 25 appended. I must have missed this somewhere because I don't ever recall reading this anywhere. Am I missing something here? Is there such a notation in the E/M guidelines? If so, can you point me in that direction?
Here is the scenario....a patient presents with hearing loss and dizziness. Upon exam the provider determines the patient has bilateral cerumen impaction. The cerumen was removed and the ears were lavaged and curetted. The provider reported code 69210 for the removal (which is correct since the cerumen was removed with instrumentation) and also reported an E/M code with modifier 25. This is a new patient.
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P