# new coder needs help with E/M or procedure



## ggparker14 (Aug 23, 2011)

Removal of splinter in finger. Would this be considered to be included in E/M or need to be coded as procedure.

Documentation reads: digital block 0.25% bupivaccine s/epi. Removed ulnar edge of nail with scissors. Wood splinter completely removed in pieces.

Thanks for any help.


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## Sueedwards (Aug 24, 2011)

Good Morning. 
I think that since he gave a digital block that it is a separate procedure.  You can also do the E/M level with the modifier 25. 
thanks, Sue


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## kak6 (Aug 24, 2011)

look at 10120


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## kristyrodecker (Aug 26, 2011)

I think that the FB removal is included in the E/M unless an incision is made as part of the removal. If the physician made an incision then you would use code 10120 and append 25 to your E/M.

10120: _Incision_ and removal of FB, subcutaneous tissue; simple


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## kissie (Sep 21, 2011)

I agree with Ms.Rodecker, they must make an incision to be able to code the procedure.


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## kak6 (Sep 21, 2011)

Qurey the physician and ask what he did with the scissors, maybe he did open it more to remove the FB. then code 10120. If you find you should not code this procedure then only code the block 64450


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## amber.krasny (Nov 10, 2011)

Sueedwards said:


> Good Morning.
> I think that since he gave a digital block that it is a separate procedure.  You can also do the E/M level with the modifier 25.
> thanks, Sue



Hi Sue, Why is it a given to say that you can also bill the E/M code with the procedure?  
Amber


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## Sueedwards (Nov 11, 2011)

That is the use of modifier 25.... above and beyond - since the physician is doing a procedure and normally after his initial assessment (e/m level) he is doing above an e/m level....

Did I explain that clear enough..... Thanks, Sue


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## amber.krasny (Nov 11, 2011)

Hi Sue,
No, can you help me understand a little better on why we would be allowed to use modifier when modifier 25 is for a significantly separate identifiable service, not for services above and beyond. How can we just ignore what the E/M guidelines indicate just because this is in the ER?  I know someone who would not add the E/M with 25 if the services in the ER are not separate from the procedure and they lost a job opportunity because of this but it looks to me like we just routinely add the E/M code regardless that a procedure for the same diagnosis is performed. How do we justify this as significantly separate?

Thanks and just trying to understand why this would be the case!


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## Sueedwards (Nov 11, 2011)

That was why I asked if it made sense.... I know it is confusing.  Let me think about what reference of material best describes the usage of E/M services in the ER with the use of modifier 25.... 

I will send it along - do I have your email?  If anyone else knows of a great reference that explains this...please let's pass it along, in the meantime I am going to look.... 
Thanks, Sue


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## amber.krasny (Nov 11, 2011)

Hi Sue,

Thank you and that would be great! I just joined this forum and am still becoming familiar with how to use it.  My friend has yet to sign up and join yet, she works uncredentialed, scary but true.  Any help anyone can provide would be great and my email is amber.krasny@yahoo.com. Thank you so much!  I just purchased the AAPC ED exam guidelines for her and in there is also looks at the surgical package in the ER as the same as the guidelines... so I guess it is just hard for me to wrap my brain around how a lacerated finger repair can also have an E/M since there was nothing additoinal or seperate examined.  Thanks again and I think I probably somehow hijacked this post. Sorry!


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## Sueedwards (Nov 11, 2011)

Amber you are fine... these posts on the forums are great for everyone that has questions - you get to learn so much.  Most likely I will get back to you on Monday.... 
Also you can do an AAPC search on modifier 25 - that should bring up some good sites for you to get started on.  

Thanks, Sue


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