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E&M vs. minor procedure

  1. Default E&M vs. minor procedure
    Medical Coding Books
    I have a question that I'm hoping for clarification or where I can get documentation regarding coding and E&M level instead of a low paying minor procedure? I have been told that I can choose an e&m level if the procedure performed pays less (ie: injection 90772). Is this true?

  2. #2
    Location
    Madison Area Chapter in Madison WI
    Posts
    114
    Default
    You should code based on the services rendered. If the patient received just the immunizations, the appropriate administration code(s) would be billable. If an E/M service was provided in addition to the immunization, you could bill an E/M, but keep in mind, the documentation must support that "a significant, separately identifiable" E/M was provided. Hope that's helpful.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  3. Default
    Thank you, that is helpful. What do you do though when the Dr. doesn't want to code the procedure because it pays less than the E&M level? There is no documentation to warrant an E&M with the procedure, so he only wants the E&M. Is this OK?

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default NO
    Quote Originally Posted by sheffner1 View Post
    Thank you, that is helpful. What do you do though when the Dr. doesn't want to code the procedure because it pays less than the E&M level? There is no documentation to warrant an E&M with the procedure, so he only wants the E&M. Is this OK?
    NO ... you can only code what is documented. Does you physician look good in stripes or blaze orange? If he keeps this up, that's what he'll be wearing.

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    Location
    Madison Area Chapter in Madison WI
    Posts
    114
    Default
    Tessa is correct. It is illegal to bill for services that aren't provided and documented. I hope your provider will listen to you. As a professional coder, please be aware of what your provider is doing. If you are uncomfortable, you might want to consider a change of employers.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  6. #6
    Default
    for all E/M services, you have to meet the key components whether it be all three or two. You should never bill an E/M service if you do not have sufficient documentation.

    Always bill what is documented as our other members have stated.. If your physician doesn't like the reimbursement for 90772, tell him not to give therapeutic injections anymore and to actually document the E/M's. doctor or not, he has to work for his $$ too. or tell him to negotiate that rate in his insurance contracts, but you are not to bill an E/M because it's fraudulent.

  7. #7
    Default If it's not documented--it wasn't done
    I agree 100% with Claudia Tessa and ARCPC. A common saying in the coding world is "if it's not documented--it wasn't done". I would sit down with this provider and explain that for every service billed they have to be documented. Give the provider a chance to correct his/her actions. If they do not respond correctly, I would seriously advise looking into another job, but hopefully it won't come to that.
    Hope this helps!
    Carrie, BS, CPC

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