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Would you bill the E&M? If yes, why?

  1. #11
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Medical Coding Books
    truely the assement is not SIGNIFICANT, it is not beyond what is necessary for the procedure there would need to be more assessment such as a description of a full body scan, the provider must know the answers to pertinent history question as well exam of the affect area to know what kind and how deep of an excision is needed, you cannot separate out the necessary elements of the eval from this procedure to be left with anything significant for billing. Just because the patient is a new patient does not automatically indicate that a visit level can be charged. I understand what every one is saying but honestly without the black and white dictation we cannot give credit for anything else.

    Debra A. Mitchell, MSPH, CPC-H

  2. Default E&m-25
    Quote Originally Posted by mitchellde View Post
    Just because this is a new patient does not automatically mean you get a new patient visit level. The documentation must support the visit level. Every procedure has as an inherent part of the procedure an assessment necessary to perform the procedure and to bill an additional assessment it must over above and beyond (significant and separately identifiable) what is needed for the procedure. In otherwords the provider will not be able to perform the procedure with a blindfold on! The documentation provided in this case is indicating an assessment only for what is required for the procedure and nothing significant to warrant a separate E&M.
    I hope this is what you are wanting.
    I just posted my senario, my son went in to the dr's office because he had wax in his ear, the nurse wrote the reason for the visit, the doctor looked in both ears and irrigated the left ear, and cerum removed. they billed an 99213-25 The only documentation was 2 lines written by the doctor about what she did as stated above. When I asked to speak to someone in billing, they said well the nurse stated there was a d/c of blood in the ear. wouldn't the nurses notes be an inherent part of the visit to perform the procedure. I know I am rusty, but the reason for the visit was cerum in the ear, nothing else. Thanks
    Last edited by classicblue21; 01-26-2012 at 09:05 PM. Reason: they also billed removal of cerum

  3. #13
    Location
    Ellenville, New York
    Posts
    1,177
    Default They billed for removal?????
    Quote Originally Posted by classicblue21 View Post
    I just posted my senario, my son went in to the dr's office because he had wax in his ear, the nurse wrote the reason for the visit, the doctor looked in both ears and irrigated the left ear, and cerum removed. they billed an 99213-25 The only documentation was 2 lines written by the doctor about what she did as stated above. When I asked to speak to someone in billing, they said well the nurse stated there was a d/c of blood in the ear. wouldn't the nurses notes be an inherent part of the visit to perform the procedure. I know I am rusty, but the reason for the visit was cerum in the ear, nothing else. Thanks
    As in 69210? Egad, if I had a dime every time I saw this code used improperly, you wouldn't see me here - I would be hiding away in the Cayman Islands!

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

  4. #14
    Location
    Evansville Indiana
    Posts
    451
    Default e/m
    I totally agree with Debra. Unless the physician did something [B]over and above [B]what is normally needed to assess for and perform the procedure, according to CMS, there is [B]No[B] billable E&M. 25 modifiers with these type of procedures are on the OIG list this year.
    LeeAnn

  5. #15
    Location
    Milwaukee WI
    Posts
    4,466
    Default NOT a social history
    Quote Originally Posted by kathy a View Post
    And actually you do have a past social history on the patient-who states about her not having any cancer.
    This statement is NOT social history. Social history would refer to marital status, tobacco or alcohol use, safe sex practices ... for younger patients level of schooling or whether they attend day care, etc.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Default
    Quote Originally Posted by sjsantjer View Post
    Would you bill the E&M? If yes, why? Thank you for your help!

    Old patient been over 10 years since last visit.

    CC:
    1. Check mole. Back, raising, irregular, present years. Pt Concerned, hard for pt to see it.
    2. Check R Hand. Rough area, present for months. No Rx yet.

    Current meds…
    KNA
    HX skin Cancer: No
    ROS: 14 reviewed with pertinent answers listed.

    Exam: Pt is well developed, well nourished, oriented x 3, not acute distress, affect appropriate. Back, inflamed Red keratotic papule 8mm. Rt Ext, one red keratotic papule.

    MDM:
    1. Inflamed SK/Other back
    Bx x1 etc.….
    Bx report came back Seborrheic keratosis showing irritation, inflammation.

    2. Actinic Keratosis
    LN2 x1 etc.…

    Dr would like to bill:
    99202-25
    11100
    17000
    I used the CMS scorecard as well and yes an E/M can be billed based on the documentation. Its a problem focused exam. I came up with 99202 as well.

  7. #17
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Quote Originally Posted by simonewill7 View Post
    I used the CMS scorecard as well and yes an E/M can be billed based on the documentation. Its a problem focused exam. I came up with 99202 as well.
    I agree the E&M meets the criteria for the 99203 HOWEVER... It does not meet the criteria to bill it in addition to the procedure. There is nothing in the exam that is significant to the procedure, only exactly what is needed for the procedure.

    Debra A. Mitchell, MSPH, CPC-H

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