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Thread: How to bill for EM when both cosmetic and medical

  1. #1

    Default How to bill for EM when both cosmetic and medical

    AAPC: Back to School
    The patient schedules a follow-up EM for a noncovered cosmetic condition.
    At the time of the EM the patient also wants another covered condition addressed.

    how do you bill an EM for this situation? Would the primary dx be based on the chief complaint (cosmetic condition)? If so, then will you get any insurance reimburement for the evaluation of the medical condition?

  2. #2
    Join Date
    Apr 2007
    Duluth, Minnesota


    I don't quite understand the question so I'm going to "assume" a bit:
    I'm assuming the patient had a recent cosmetic surgery and is within the global period for it, coming in for follow up (which 'normally' wouldn't be charged), BUT - also has another, UNRELATED issue going on that is addressed. In this case, I would score out the E/M based on the unrelated issue and give the appropriate level with a modifier .24 on the E/M to take it out of the global for the cosmetic issue. I would code and link unrelated issue(s) as primary/secondary dx's. You can code the 99024 (no charge) follow up code for the cosmetic follow up to help track the follow up services for it and link it to your Vcode follow up.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default -24 modifier

    I agree with Donna ... code the appropriate level E/M for the unrelated condition and append the -24 modifier to that E/M.

    F Tessa Bartels, CPC, CPC-E/M

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