Primary Care Coding Alert

See how you rationale stacks up to these experts' opinions

You should be able to bill for an E/M that's related to a same-day procedure as long as you do more work than the usual -no or go- preoperative examination.

When a patient comes in with a new problem and the physician examines the patient, then performs a minor procedure to correct the problem, determining whether the E/M service warrants reporting can be tricky.

Apply the principles discussed in -These Tips Help You Decide if Destruction, I&D Visits Also Warrant E/M Service- to the following examples. An Unrelated Problem Generally Supports Modifier 25 1. Laceration repair: If a patient has fallen and cut his forehead open, and the doctor merely glances at the wound and confirms that it needs stitches, the doctor shouldn't bill for an E/M separate from the stitching, says Quinten A. Buechner, MS, MDiv, CPC, president of ProActive Consultants LLC in Cumberland, Wis. But if the physician checks the patient for concussion and other problems before stitching, the documentation of that supports a separate E/M. 2. Cerumen removal: On the other hand, the cerumen removal scenarios that appeared in the June 2006 Family Practice Coding Alert article -Tried-and-True Tips Turn Denials Into 9921x + 69210 Payments- contain separate diagnoses--a factor that, although not required, makes justifying a separate E/M service easier.

The scenarios all dealt with patients who did not present for scheduled cerumen removal. In these cases, -the documentation of the chief complaint, a history of the patient's medical conditions, the examination of more than the ear, and a medical decision to remove the impacted cerumen warrant an E/M service in addition to the cerumen removal,- says Steven M. Verno, CMBSI, director of reimbursement for Emergency Medical Specialists in Hollywood, Fla.

Appropriate diagnoses that may warrant a separate E/M service from cerumen removal include ear pain (388.7x, Otalgia), otitis media (381.00-382.9), or another illness (such as 465.9, Acute upper respiratory infections of multiple or unspecified sites; unspecified site). 3. Arthrocentesis: The author of Coding With Modifiers, Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, CCP, EMS, president of Medical Professionals Inc. in Indianapolis, is more conservative.

She gives this example: A patient comes in with knee pain (719.48, Pain in joint; other specified sites). The physician diagnoses fluid in the joint and then performs an arthrocentesis (20610, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).
 
If the patient also needs diabetes counseling, you can report the counseling separately and attach modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M to receive payment for this service and the procedure. 

But if the [...]