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Oncology & Hematology Coding Alert

Reader Questions:

Don't Code Built-In Service as Separate E/M

Published on Fri Jan 25, 2008

Question: A nurse practitioner (NP) sees a 65-year-old established patient. Before administering treatment, the NP takes a brief history, checks the patient's vital signs, and rules out any contraindications for care. Can I report an E/M in addition to codes for procedures? South Carolina Subscriber Answer: Probably not. All CPT codes have an inherent E/M service (a brief patient assessment required before undergoing any type of procedural service) built into them. The E/M the NP provides the patient during the visit must go beyond this inherent assessment in order to report a significant, separately identifiable E/M code. From your description of the NP's actions, she did not do much beyond providing the evaluation service built into most CPT codes. If you can identify a problem that the NP assesses and separately treats (at the direction of the physician), you might be able to report an E/M service along with the procedure codes.
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