EM Coding Alert

Question: After a level-four office evaluation and management (E/M) service for an established patient, the provider decides to perform spinal manipulation. How should I report this encounter?

Arkansas Subscriber

Answer:

It depends on whether or not the provider used anesthesia, as there are separate codes for spinal manipulation with/without anesthesia.

Go back and check the notes. Then, report one of the following code combos:

• Anesthesia affirmative: If the provider used anesthesia, report 22505 (Manipulation of spine requiring anesthesia, any region) for the manipulation and 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) for the E/M with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99214 to show that the E/M and manipulation were significant, separate services.