Wiki Billing New Pt visit along with debridments

[csparks1988]

I have a physician asking since he can not bill both new visit and debridements together without something separate and identifiable from the reason pt is being seen ie..the wound, can he bill the office level charge only, or does it absolutely need to be the debridement. I have advised, the decision to perform a surgical procedure superceeds the EM level charge. is this correct?

 

[thomas7331]

I have a physician asking since he can not bill both new visit and debridements together without something separate and identifiable from the reason pt is being seen ie..the wound, can he bill the office level charge only, or does it absolutely need to be the debridement. I have advised, the decision to perform a surgical procedure superceeds the EM level charge. is this correct?

If there is no separately identifiable E&M, then only the procedure can be billed - billing only an E&M would be a misrepresentation of services. But while you're correct that the decision to perform a minor procedure is included in the reimbursement for the procedure, wound care is a bit of a special case. Wounds, especially chronic wounds, typically involve an underlying disease (e.g. diabetes, vascular disease, neuropathy, infection, etc.) and the E&M involves evaluation of these factors and the creation of a care plan to treat and allow the wound to heal properly would generally support a modifier 25 for E&M that is separately identifiable from the normal pre-operative work and the decision for the procedure that is inclusive. If this is a new patient, I would think that any of those factors in the documentation would likely support some kind of E&M charge in addition to the debridement.