Results 1 to 4 of 4

E/M Level with a Procedure

  1. #1
    Question E/M Level with a Procedure
    Medical Coding Books
    I needing proof and resources with a problem that was brought to me to look into. Our facility has always charged a level with a procedure and added a -25 modifier to the level.

    Example:

    Patient comes in with laceration to arm, phys does simple repair, documentation is there to give a E/M level 3 and also the procedure.

    Should we only be charging for the procedure?

    I was told that if the ONLY WAY to chg both a level adn procedure is if : Example:
    phys treated the laceration and the patient also had a cold (but this was not the reason for the visit) and the phys provided med for the cold then I could give the E/M and the procedure. But ONLY if the phys had gone "above and beyond" (cpt guidelines).

    HELP WOULD BE APPRECIATED!! NEED TO TAKE THIS TO SUPERVISER!!

  2. #2
    Location
    South Bend
    Posts
    23
    Default
    Please do not confuse 25 & 57. Modifier 57 means the decision for surgery. Modifier 25 does NOT.

    Without seeing notes there is no way to determine if the office visit was medically necessary above and beyond what was required to make the decision to suture the laceration.

    Sandy Goodknight, CPC, CPMA, CEMC
    Indiana

  3. #3
    Default
    This is in an emergency room setting!! Thanks!

  4. Default
    Quote Originally Posted by Brandilyn View Post
    I needing proof and resources with a problem that was brought to me to look into. Our facility has always charged a level with a procedure and added a -25 modifier to the level.

    Example:

    Patient comes in with laceration to arm, phys does simple repair, documentation is there to give a E/M level 3 and also the procedure.

    Should we only be charging for the procedure?

    I was told that if the ONLY WAY to chg both a level adn procedure is if : Example:
    phys treated the laceration and the patient also had a cold (but this was not the reason for the visit) and the phys provided med for the cold then I could give the E/M and the procedure. But ONLY if the phys had gone "above and beyond" (cpt guidelines).

    HELP WOULD BE APPRECIATED!! NEED TO TAKE THIS TO SUPERVISER!!
    Of course you do in the ER. ER patients are considered new patient, new problem. You would code the visit and the procedure both for professional AND facility.

Similar Threads

  1. E/M level for planned procedure
    By shyde@fchn.org in forum Urology
    Replies: 1
    Last Post: 03-19-2015, 07:55 AM
  2. Replies: 0
    Last Post: 01-28-2013, 09:52 PM
  3. procedure w/no E/M level
    By alices in forum Emergency Department
    Replies: 2
    Last Post: 11-24-2010, 10:14 AM
  4. H&P performed with level 3 visit, raise level 4?
    By LynnS.321 in forum Orthopaedics
    Replies: 1
    Last Post: 10-23-2009, 07:28 AM
  5. E/M Level with additional procedure
    By bandrewso5 in forum Emergency Department
    Replies: 1
    Last Post: 11-28-2008, 12:18 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.