Wiki ANOTHER 25 mod question

[Lynda Wetter]

Clarification needed please.
Any supporting documentation you can provide with your responses is greatly appreciated.

Patient comes in with a laceration to the head.
We do a expanded problem focused E/M checking vitals, neuro functions things like that, then we suture the laceration.
Do you feel this justifies the office visit being billed with a 25? I feel like no it does not justify unbundling the visit.

Thanks!

 

[Pam Warren]

You're absolutely right....No it does not. The vast majority of the time, an E&M at the same time as a minor procedure is bundled into the procedure. Check your CCI edits, Chapter 1, on the section addressing E&M.

 

[Lynda Wetter]

You're absolutely right....No it does not. The vast majority of the time, an E&M at the same time as a minor procedure is bundled into the procedure. Check your CCI edits, Chapter 1, on the section addressing E&M.

Thanks Pam, I am very familar with the CCI edits and the numerous other sites including the local carrier site that states the same. It is just so frustrating trying to get other to see what I already know. You know hte saying "you cant teach an old dog new tricks", well thats where I am at!

Thanks so much!

 

[Pam Warren]

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an
E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is "new" to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.

Hope this helps!