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Thread: new coder needs help with E/M or procedure

  1. #1

    Default new coder needs help with E/M or procedure

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    Removal of splinter in finger. Would this be considered to be included in E/M or need to be coded as procedure.

    Documentation reads: digital block 0.25% bupivaccine s/epi. Removed ulnar edge of nail with scissors. Wood splinter completely removed in pieces.

    Thanks for any help.

  2. #2
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    Good Morning.
    I think that since he gave a digital block that it is a separate procedure. You can also do the E/M level with the modifier 25.
    thanks, Sue
    Susan Edwards, CPC, CEDC
    smecoder@gmail.com

  3. #3
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    look at 10120
    KAK6CPC

  4. #4

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    I think that the FB removal is included in the E/M unless an incision is made as part of the removal. If the physician made an incision then you would use code 10120 and append 25 to your E/M.

    10120: Incision and removal of FB, subcutaneous tissue; simple

  5. #5
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    I agree with Ms.Rodecker, they must make an incision to be able to code the procedure.

  6. #6
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    Qurey the physician and ask what he did with the scissors, maybe he did open it more to remove the FB. then code 10120. If you find you should not code this procedure then only code the block 64450
    KAK6CPC

  7. #7

    Default

    Quote Originally Posted by Sueedwards View Post
    Good Morning.
    I think that since he gave a digital block that it is a separate procedure. You can also do the E/M level with the modifier 25.
    thanks, Sue
    Hi Sue, Why is it a given to say that you can also bill the E/M code with the procedure?
    Amber

  8. #8
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    That is the use of modifier 25.... above and beyond - since the physician is doing a procedure and normally after his initial assessment (e/m level) he is doing above an e/m level....

    Did I explain that clear enough..... Thanks, Sue
    Susan Edwards, CPC, CEDC
    smecoder@gmail.com

  9. #9

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    Hi Sue,
    No, can you help me understand a little better on why we would be allowed to use modifier when modifier 25 is for a significantly separate identifiable service, not for services above and beyond. How can we just ignore what the E/M guidelines indicate just because this is in the ER? I know someone who would not add the E/M with 25 if the services in the ER are not separate from the procedure and they lost a job opportunity because of this but it looks to me like we just routinely add the E/M code regardless that a procedure for the same diagnosis is performed. How do we justify this as significantly separate?

    Thanks and just trying to understand why this would be the case!

  10. #10
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    That was why I asked if it made sense.... I know it is confusing. Let me think about what reference of material best describes the usage of E/M services in the ER with the use of modifier 25....

    I will send it along - do I have your email? If anyone else knows of a great reference that explains this...please let's pass it along, in the meantime I am going to look....
    Thanks, Sue
    Susan Edwards, CPC, CEDC
    smecoder@gmail.com

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