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E&M or I&D

  1. Default E&M or I&D
    Medical Coding Books
    Scenario: Patient has wound on buttock for 3 months. Said it waxes and wanes, today more tender. Dad has had multiple abscesses, not culture proven but hghly suspicious for MRSA> No fevers or chills. Vitals taken. Patient in no acute distress. She has a very small 3-4mm area of folliculitis with a tiny degree of purulence. I lanced it with 23-gauge and cultured the secretions. Going to cover with Bactrim as well as Keflex. Cultures pending.

    Should this be coded with just an E&M or 10060. Thanks for the help.

  2. Default
    If the patient came in with this problem for the first time and the physician had to examine her and then made the medical decision at that point to do an incision and drainage, I would use both, the E/M code and code 10060.

  3. #3
    Default
    I would be careful with a visit where the E/M portion does not qualify for more than problem focused.
    According the the NCCI policy manual for medicare services under Chapter III

    "The decision to perform a minor surgical procedure is included in teh payment for the minor surgical procedure and should not be reported separately as an E&M......If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply."

    I would make sure the E&M is clearly separately identifiable and unrelated.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  4. #4
    Default
    I would only code the E&M since most minor procedurs are bundled into the E&M service.
    EVELYN KIM , MBA, CFE, CPC, CPMA,CRC
    Manager, SIU

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default The other way around
    Quote Originally Posted by Evelyn Kim View Post
    I would only code the E&M since most minor procedurs are bundled into the E&M service.
    Actually, Evelyn ... it's the other way around. The E/M service is bundled into the procedure. Just because many payers will choose to pay the LOWER of these two does not change the fact that the E/M service is bundled into the procedure.

    I would code only the 10060.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Default
    [QUOTE=FTessaBartels;199470]Actually, Evelyn ... it's the other way around. The E/M service is bundled into the procedure. Just because many payers will choose to pay the LOWER of these two does not change the fact that the E/M service is bundled into the procedure.

    I would code only the 10060.
    HI I WAS WONDERING ABOUT THIS SO YOU WOULDNT BILL THE E/M CODE AT ALL IM AM NEW TO CODING LEARNING EVERYTHING ON MY ON. I HAVE HAD A PROBLEM WITH THIS 10060

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