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Can I bill an E&M for a scheduled procedure

  1. #1
    Default Can I bill an E&M for a scheduled procedure
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    I have a question about whether or not I can bill for an E&M with modifier -25 in the following scenario (I'll be brief):

    A patient comes in to see the urologist for a bladder scan that was planned and scheduled a month prior. The doctor documents there has been no improvement since the last visit and goes over the same treatment options that were discussed at the last visit. No new medication was prescribed and patient will continue on the same medication.

    Is 99213 -25 the correct E&M service? Or no E&M at all?

    Zaida, CPC

  2. #2
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    No E/M is my opinion

  3. #3
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    I would have to say no E/M. I believe what was gone over with the patient would be part of the scan. Nothing changed.

  4. #4
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    I don't see why the doc can't charge an E/M, (not sure if his documentation would support a level 3 - you'd have to score it out to see) - I don't see a need for a .25 modifier either, as I don't see a procedure being done at this visit. It might support a level 2 visit ... Bladder Scans don't have a global period. I think it was an review of things/issues/etc and the doc can charge an E/M, documentation supporting of course.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  5. #5
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    Thanks to everybody for your input. I don't think we can bill the E&M either. In reply to Donna's response, even though the bladder scan does not have a global period, it is still defined as a procedure. But again thank you.

    Zaida

  6. #6
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    Zaida, yes that's correct, the scan is a procedure - maybe I read the post wrong, but I thought you said the scan was done a month BEFORE the office visit right? (not the day you're speaking of now) ..the day of service you're speaking of now is an office visit correct? provider reviewing the scan with no new plans or changes...... why wouldn't the office visit be coded?
    Maybe I'm missing something, can you tell me why you think this E/M shouldn't be billed out?
    going by what your original post question was - there's no reason not to bill an E/M that is supported by documentation. UNLESS the provider wants a "no charge" visit.

    THANKS!
    Donna, CPC, CPC-H

  7. #7
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    I believe the procedure was "planned and scheduled" one month prior to the visit correct?

  8. #8
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    {{shrugs}} I don't know mbort - I'm confused. I read the post as the patient came in a month prior for a visit and had the scan, coming back now basically as a "follow up" of sorts, going over results, etc - even though no changes to speak of - the provider still went over things, time spent with patient, and there isn't a global issue preventing a charge for the E/M, ...so I'm not sure why the E/M can't be coded and billed out...
    I must be missing something...
    Donna, CPC, CPC-H

  9. #9
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    The procedure was planned and scheduled.

    Zaida

  10. #10
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    planned and scheduled when? Planned and scan done a month before - and planned come back in one month for follow up? or planned a month ago and coming now (a month later) for the scan? if that's the case, then probably just the scan only. But if the scan was done a month before the office visit - then I'd say yes -the E/M can indeed be coded/billed.....
    (I hate to be rock here, but I'm not getting it)
    Last edited by dmaec; 09-17-2008 at 12:20 PM.
    Donna, CPC, CPC-H

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