Pediatric Coding Alert

Question: A Medicaid patient came to the office on an emergent basis with several lacerations to the arm. Our physician sutured the lacerations. Can we bill for the office visit along with the repair, or is the office visit included in the repair?Pennsylvania SubscriberAnswer: The correct answer depends on how extensive the physician's assessment was or whether he provided other services during the encounter. If he performed another service or if his assessment of the patient was over and above that normally provided with laceration repair, you can report the appropriate E/M code from 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient ...). Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. The physician's documentation should clearly establish that the E/M service [...]