Visit 1: New patient presents with complaints of blood in urine. A full new patient E&M is performed and documented; MD orders CT and lab work. Patient is scheduled to return to clinic for a cysto.

Visit 2: Patient (now established) presents for cysto. MD queries the patient regarding any new signs or symptoms related to previous/continued complaint of blood in urine and documents history and a new exam. Cysto procedure is performed and a bladder tumor is found; after the procedure the MD discusses results of CT, lab work and cysto with the patient. The MD reviews with the patient the findings of the cysto and a decision for surgery is made. Risks and benefits are discussed and the surgery to remove the tumor is scheduled for the following week. No other problems are reviewed, discussed or documented.

Can the MD bill an E&M with a 25 modifier along with the cysto for visit #2 based on time spent with the patient discussing the cysto procedure findings of a tumor and explaining the options and risk/benefits of surgery.