Based on information provided... no additional evaluation and management service is supported.
Case One: "If a routine physical is done and the physician finds a new problem and sends pt. for an u/s can I charge a regular E/M with a 25 on it?"
If the ultrasound findings result in an additional visit where there will be further evaluation and then management of the finding, the provider would bill for the additional visit, typically a different date.
Case Two: "excision is done, but physician documents enough to qualify for an E/M can you charge for that. The excision was a pre planned appt."
The decision for the excision is made at a previous visit, the only medically necessary evaluation and management service is to verify that the patient is still medically stable for the procedure and is not separately billable.
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