Wiki Billing E/M codes along with a therapeutic procedure or a diagnostic procedure

[branda_beal@yahoo.com]

We are struggling with when or if it is ok to bill an E/M office visits with a therapeutic procedure or a diagnostic procedure. How do you know what is considered therapeutic and what is diagnostic? We were told it is up to the discretion of the physician. If a provider only pays for either the E/M or the procedure, can I use modifier 25 to get both paid?

Thank you!

 

[foxsd]

Do you have an example of what you're trying to do?

Anytime anything is done, & billed for outside of the E&M there should be a -25 modifier.

 

[branda_beal@yahoo.com]

We are doing overall chart reviews and audits. We are seeing multiple procedure codes billed with E/M codes. Examples would be ear lavage with E/M visit, skin tag removal, or immunizations

 

[mitchellde]

We are doing overall chart reviews and audits. We are seeing multiple procedure codes billed with E/M codes. Examples would be ear lavage with E/M visit, skin tag removal, or immunizations

To bill an E&M with a 25 modifier documentation must clearly reflect services that are relevant to the patient presenting problem and yet over above and beypnd the evaluation necessary for the procedure.
If a procedure is scheduled in a previous visit then for the day of the procedure you cannot bill an E&M as there is no significant evaluation being performed, the evaluation needed to determine if the procdure should be done was already performed in the previous visit and cannot be charged out again.