well, perhaps they feel that your E/M level isn't a significant separately identifiable reason. It has to be "above" and "beyond" the usual preservice and postservice work associated with the procedure. Certainly, it can have the same dx but if there really isn't a significant separate reason for the E/M it shouldn't be charged.
How often does the patient have this done? Maybe it's been flagged and they feel an E/M shouldn't be billed out with it.
you can appeal it, if you have supporting documentation. You can bill both with the modifier on teh E/M -"if" it meets the requirements.
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