Wiki Billing for an E&M with planned US

[gniedermaier]

One of my surgeons specializes in conditions of the thyroid. Often times he has the patient scheduled in 3 months to come back to review labs and perform an in office ultrasound. Often he wants to bill an o.v. with the ultrsound. I do not feel this is appropriate since the u.s. was planned 3 months earlier. True, it is not a procedure but still do not think the E&M should be billed seperately. Any insight is appreciated. I have read through the NCCI and looked through the radiology section of the Medicare manual....still cannot find anything.

Gina N.

 

[jimbo1231]

E&M

The fact that it is a planned procedure wouldn't eliminate coding an E&M. If your doc documented ( and did..no cloning!) a separately identifiable E&M, it should be billable.
The other issue is medical necessity. If there is no reason medically to do an E&M you could make that argument with the provider. But frankly, a follow up visit doesn't require more than basic medical necessity. For example provider does a limited E&M because of patient condition related to getting U/S.

Regardless, some payors might not pay for both. And remember the 25 modifier!

Jim S.