Ambulatory Coding & Payment Report
You Be the Coder: Laceration Patient
Question: With the advent of the new ambulatory payment classification (APC) system, we wish to code a simple emergency department (ED) laceration patient with a level of service of 99283 and also a laceration procedure charge. My medical records department states we cannot append a procedure charge because it is not separate from the main reason for the visit. Can we code both the visit and the procedure and get reimbursed for both?Maggie-May Smith
Mesa, Ariz.
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Answer: Your medical records department is correct that both an ED visit and a procedure code should be reported only when the ED visit is separate from the procedure.
Modifier -25 is billed with an evaluation and management (E/M) code to indicate that on the same day a procedure was performed, the patients condition required a significant, separately identifiable E/M service (even though the E/M service may be necessary because of the symptom or condition for which the procedure was provided). Modifier -25 is used with an ED visit:
That is above and beyond the procedure performed.
That is beyond the usual preoperative and post- operative care associated with the procedure.
When a separate history was taken, a separate physical was performed, and a separate medical decision was made and is documented in the medical record.
Source for You Be the Expert is Laura Siniscalchi, RRA, CCS, CCS-P, CPC, education coordinator at Beth Israel Deaconess Medical Center in Boston. |
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- Published on 2000-10-01
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