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

  1. #1
    Aberdeen, SD
    Default Would you bill the E&M? If yes, why?
    Medical Coding Books
    Would you bill the E&M? If yes, why? Thank you for your help!

    Old patient been over 10 years since last visit.

    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…
    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.

    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:

  2. #2
    Greater Orlando
    Please note you'll likely get more and faster answers when you ask your E/M qeustion in the E/M forum.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  3. #3
    A new patient is one who hasn't received services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice within the past three years. Here's what I would do-

    Since the patient didn't come in for a planned procedure, I would bill the 99202 with 11100-59 and 17000.

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  4. #4
    Boise, Idaho
    I would 99202-25, 11100, 17000-59. For the same reason. The procedure wasn't planned.

  5. #5
    Columbia, MO
    I would not bill an E&M because even though the procedure was not planned the assessment is not significant meaning it is not any more of an assement than what is needed to perform the procedures. The documentation must be thereor it cannot be billed.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Everett, WA
    This thread and resultant diverse replies are one of the reaasons I find E/M coding so challenging, maddening and compelling It's also the reason why I'm utilizing the study guide in order one day to take the CEMC test. Admittedly, I'm somewhat confounded by the last answer. No EM at all for this new patient visit? Please elaborate a little more as I'm having a little difficulty understanding the thought process here. ---Suzanne E. Byrum CPC

  7. #7
    Columbia, MO
    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.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Everett, WA
    Debra, indulge me, please, as I value your input as a veteran board member....Therefore, as the question was first submitted with the documentation presented and based upon this 'inherent part of the procedure' (this is a grey area, indeed), it still is insufficient to warrant an EM code assignment? Am I understanding you correctly? Guess, I really do need these EM studies because right now I'm second guessing myself all over the place. Perhaps the question should be asked "at what point is the inherent part of the threshold reached?" based on the documentation submitted. Can this be found in writing anywhere? I'd really, really love to have that "inherent part" explained.
    ---Suzanne E. Byrum CPC

  9. Thumbs up
    Yes you can bill for a new patient visit! Looking at the Medicare scorecard-
    HPI:Location-Back, Timing-Years,Severity-Raising, Associated Signs and Symptoms-Irregular
    ROSer note 14 reviewed with pertinent answers listed.
    On the History part of the exam-Exp Problem Focused

    EXAM: Constitutional, Skin, Psych-no acute distress.
    This also would be an EPF

    MDM:New problem to examiner-4, INdependent visualization of image-2 as well as review and order lab( biopsy ) =4,Biopsy is undiagnosed new problem with uncertain prognosis+ Moderate Complexity

    On a new patient-one who has not been seen face to face in three years-youu would have EPF, EPF, Moderate= # 99202. Kathy Albert,CPC

  10. Default
    And actually you do have a past social history on the patient-who states about her not having any cancer.

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