EM Coding Alert
Capture Payment For Biopsy Result Discussion
Question: A patient came in for the biopsy report after a 90-day global procedure. The doctor talked to the patient about results and different types of treatment for 15 minutes. How can I capture payment for this visit?
Answer: You should report the appropriate office visit code, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...), based on the time your physician spent reviewing the results face to face with the patient. Since this visit is not a postoperative follow up examination related to the previous surgical procedure, but rather a visit to review the biopsy results with the patient, you can report the E/M service.
Caveat: Since you are within the surgical global, you must append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to your E/M code. Make sure your physician documented clearly in the medical records the total time spent with the patient and the counseling and coordination of care discussed.
Virginia Subscriber
EM Coding Alert
- Time-Based Coding:
Ensure Your Provider is Documenting 3 Key Points for Billing on Time Alone
Remember that counseling and coordination of care must dominate the encounter. If you’re coding office [...] - Back to Basics:
Pay Attention to 3-Year Rule to Decide Between New vs. Established Codes
The location of the encounter won’t be the deciding factor. Even before you start looking [...] - Clip and Save:
Follow this 5-Question Path to Find Out if the Patient is Really New
This tool will help you navigate the sometimes tricky new vs. established question. As noted [...] - You Be the Coder:
New Patient Vitals Won't Make the 99203 Grade
Question: A new patient presented in our office. Past medical, social, and family history were [...] - Reader Question:
Modifier 25 is Your E/M + Procedure Answer
Question: Can I bill Medicare for an office visit and cystoscopy on the same day [...] - Reader Question:
Capture Payment For Biopsy Result Discussion
Question: A patient came in for the biopsy report after a 90-day global procedure. The [...] - Reader Question:
Ensure Providers Indicate ROS Review
Question: I’ve heard that for an E/M visit, the physician is responsible for certain parts [...] - Reader Question:
Remember Prolonged Service Codes for Extra Long Visits
Question: My pediatric physician spent 105 minutes with a new patient in the office. Is [...] - Reader Question:
Follow the 3 Key Components Rule for 99304-99306
Question: How do I code if our physician went to the nursing home to see [...]
