We encounter this scenario all the time. We bill it both ways depending on the referral/request documentation. If a PCP sends the patient for a "consultation" or "consultation & treat." we will bill appropriate 99241-5 code w/mod 25/57 and appropriate hemorr removal code. We do get paid even from BCBS. Yes, sometimes we have to fight and once in a blue moon we lose (usually b/c bad MD note). I have my MDs dictate a consult note totally seperate from the procedure note. This helps the "oh so bright" ins company reviewers see that 2 totally services were rendered. If the notes for the services are merged it is very hard to fight. We also ask the ins company if we should have the patients come back on a different day at the inconveinence of the patient so our MD can be reimbursed for the services rendered. Most of the time the ins backs down and we receive payment. Hope this helps!

Anna Barnes, CPC, CGSCS