Ob-Gyn Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: A primary-care physician refers a patient to our ob-gyn office for an endocervical curettage. How do we bill for both the new patient consultation and the procedure on the same day? Do we just bill for new patient visit (99205-25) and 57505?

Anonymous Michigan Subscriber


Answer: You should bill as you have outlined, using 99205 (office or other outpatient visit, new patient; comprehensive history and examination; high- complexity medical decision-making), appending this with the -25 modifier (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service), along with 57505 (endocervical curettage [not done as part of a dilation and curettage]).

Bear in mind that when using modifier -25, the procedure must meet the definition (significant, separately identifiable), and also that not all insurance companies will pay for an office visit and a procedure on the same day. Provide all the documentation you can, but its best to know beforehand what your carriers will and wont pay for.