EM Coding Alert

Take charge of your E/M training and evaluate yourself.

Your E/M education is ongoing, beneficial, and can always use some brushing up. Last month, in E/M Coding Alert Vol. 2, No. 8, you took a three-question quiz. Now check your answers to see where you need to hone your skills. 

Answer 1: Yes, you can report the E/M service separately. Code 11055 (Paring or cutting of benign hyperkeratotic lesion [eg, corn or callus]; single lesion) has a zero-day global period. 

If the E/M procedure or service performed is during the post-operative global period and is directly related to the surgery and the recovery of that surgery, then it is not billable. However, there is no post-operative period for this procedure, thus the E/M service is billable. 

Answer 2: No, you cannot report the office visit. Because 11750 (Excision of nail and nail matrix, partial or complete [eg, ingrown or deformed nail], for permanent removal) carries a 10-day global period, the E/M is included in the surgery payment previously submitted. You wouldn’t submit anything for the routine follow-up encounter.

Answer 3: The answer depends on your payer. Unlisted codes have a “YYY” contractor-priced code designation, which means that the individual payer will determine the global period. Codes with the YYY designation are contractor-priced codes. That means your payer can determine the global period, either 0, 10, or 90 days. YYY usually applies to unlisted procedures, and the global period a payer assigns will depend on the type of unlisted service. But not all contractor-priced codes have the YYY designator. Sometimes they have a global period indicator of 000, 010, or 090 instead. To learn more, take a look at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf.

The “ZZZ” designation applies to add-on codes that you must bill with another service. There is no post-operative work included in the Medicare Physician Fee Schedule (MPFS) payment for the “ZZZ” codes. Payment is made for both the primary and the add-on codes. The global period applies to the primary code.

The “MMM” indicator describes maternity codes. The usual global period rules do not apply to codes with “MMM.” All services related to an uncomplicated birth are bundled into the surgical package for the delivery services. You’ll find that all delivery codes in the vaginal and cesarean delivery range (59400-59525) and delivery procedures after previous cesarean delivery range (59610-59622) carry a “MMM” global period.

When you see an “XXX” in the fee schedule, the global concept does not apply to the code. In other words, these services and procedures include only the service or procedure itself, and any (minor) built-in E/M service. All procedural A codes (A0021, Ambulance service, outside state per mile, transport [medicaid only] -A9999 Miscellaneous dme supply or accessory, not otherwise specified), as well as donor lung preparation services (32855-32856, Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; …) have an “XXX” global period.

Answers to this quiz were provided and/or reviewed by Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, manager of physician compliance auditing at Alleghany Health Network in Pittsburgh, Pa.