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E/M with Minor Procedures

  1. #1
    Default E/M with Minor Procedures
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    Can anyone provide assist us in clearing up the confusion of billing E&M codes when “minor” procedures are performed?

    Does the policy change if the “minor” procedure is performed at a hospital setting?
    How does this affect billing an E&M code with a minor procedure for a new patient?

    We have received conflicting information regarding billing an E/M with a minor proceure. Some documentation states you can never bill for an E/M with a minor procedure and other documentation states you can.

    Any information would be greatly appreciated.

  2. Default Minor Procedures
    Most of the procedures perfromed in the ED such as Lac Repairs, I&Ds etc are minor procedures. Minor procedures are usually defined by 10 or less global surgery days. I haven't seen anything in a long time indicating that an E&M cannot be coded with minor procedures. And since most patients in the ED are new to the physician a work up is required in addtion to the procedure. Most payers require a 25 modifier with the E&M.
    Years ago there was language in the CPT and an odd code that was to be used with minor procedures. I think that has been out of the CPT since the 90s. But that might be the source of some of the confusion.


  3. Default A new word. Perfromed
    Just realized that I was on E&M not ED. But the same holds true for other hospital sites. There might be more cases say with inpatients where the patient is known to the physician already and an E&M might not be medically necessary and shouldn't be coded. But there is no restriction on coding E&Ms in addtion to minor procedures if the E&M is documented and medically necessary.
    And I meant to say performed.


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