So since you do derm, if a new patient were to come in c/o contact dermatitis. And the physician goes over the patient's history, does the ROS, physical exam, etc...and then decides to put on a patch test the same day. The physician could not bill for an office visit (in addition to the patch testing)? That doesn't sound correct.
Our issue pertains mostly to allergy injections. If a patient comes in for their monthly allergy injection and they're also there for their yearly follow-up with the physician, BCBS is paying for the allergy injection and not the office visit. It makes no sense. So...I am trying the XU modifier with the allergy injection - in addition to the 25-modifier on the visit to see if that helps. It's only certain BCBS plans doing this - Texas, Oklahoma, Illinois, New Mexico, and a handful of other states. This was never an issue before, but now has become quite a thorn in my side. I'm watching the ones that I sent out with the XU modifier to see if that may truly be the issue.
Melissa Sandlin, CPC
Ahh.... but you overlooked one IMPORTANT point. CPT 95044 (Patch testing) isn't a minor procedure. Minor procedures have 0 or 10 postop days. For CPT 95044, the global concept doesn't apply.
In this case, if the E/M leads to the decision to do patch testing on the same DOS, you CAN bill the provider's E/M that lead to the decision to perform it separately.
Now, there are 95044 bundles in the CCI, because the if the patient is just coming in for application of the patches (decision was done previously), you can't bill for an E/M. Similar for a patient coming into the office for a routine scheduled injection (96372).
You can bill for the reading of the tests at 24, 72, 96 hours (usually a 99211 if nurse does it or 99212 if provider reads the tests). And you can bill an E/M for the final meeting with the patient to go over the results and discuss the plan of care moving forward.
In my previous post, I was talking about minor procedures (codes with 0 and 10 postop days) and the E/M that leads to the decision to perform it being
included. This came about in 2013 with the National Correct Coding Initiative. Here is the verbiage that applies to minor procedures with both new and established patient visits.
IN the NCCI Policy Manual, Chapter 3, page 8, , you will find the following instruction/rule change.
"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. NCCI does contain some edits based on these principles, but the Medicare Carriers have separate edits. Neither the NCCI nor Carriers have all possible edits based on these principles."
What this is saying is that the Evaluation and Management required to address the patient's specific chief complaint(s) is included in the reimbursement for the billable minor procedure. This would include determining the chief complaint(s), taking or updating history, review of systems, examining the patient, past family/social history, diagnosing the problem, making the decision on how to treat the problem, informing the patient, obtaining consent, and providing postop instructions. In summary, none of the aforementioned tasks/processes can be billed for separately if they are related to a billable minor procedure.
Most of the carriers are following this rule!