# E/m + 10060



## aprillerowland (May 18, 2017)

Am I allowed to bill a 99213 + 10060 or is the e/m bundled into the procedure? Where can I find proper documentation to present to my providers?
thx!


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## CodingKing (May 18, 2017)

There is a minor E&M component built intro every surgical procedure. Modifier 25 is defined as "significant and separately identifiable. so there needs to be evidence in the medical notes.


NCCI Manual states:



> If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. (Osteopathic manipulative therapy and chiropractic manipulative therapy have global periods of 000.) In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.
> 
> Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.





One of our local consulting groups wrote up a good summary of things to consider before adding modifier 25



> Here are a few questions to consider before sticking that modifier on your next claim:
> 
> Was the patient scheduled to come in for a planned study or procedure only? Did any notable events occur that would affect the service beyond the study or procedure?
> Was the evaluation and management service provided significant and separately identifiable to the procedure or diagnostic study provided at the same encounter?
> Is active management of a significant and separately identifiable illness/ailment with preventive services for additional problems identifiable in the provider’s documentation?


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