General Surgery Coding Alert

Question: Can you charge for an inpatient consult and a bedside debridement on the same day?

Louisiana Subscriber

Answer: You can bill for both services as long as the E/M service goes beyond a simple assessment of the area to be treated. Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) to the inpatient consultation code (99251-99255, Inpatient consultation for a new or established patient &) you report to inform the payer that the surgeon provided a separate E/M service above and beyond the E/M inherent to the debridement.

Report a code from the 11010-11044 (Debridement &) range, depending on the type of debridement your physician performed.

Diagnosis help: You do not have to have a different diagnosis for the consultation and the debridement.However, the documentation should show the medical necessity for the surgeon to perform the separate services and also show that the E/M service provided went beyond the normal preoperative work that is a part of every procedure.

Warning: Additionally, Medicare specifies that the decision to perform a minor procedure in itself is not sufficient justification to separately bill an E/M service. There must be documentation that the service went beyond the evaluation needed to determine the need for the procedure.