Wiki Bundled E/M issue

[meguzma86]

I work for a Nephrology practice. Our doctors perform catheter inserts, removals, and visits to the pt while they're in the hospital. The issue here is this: how do I know for sure if the visit should be unbundled? If the pt is in the hospital for some unrelated condition, eg. Pneumonia, and they have Chronic Kidney Disease, our docs consult with the pt and assess their labs and vitals since their under their care for hemodialysis treatments. But for other pts who have CKD related issues in the hospital, their catheter gets clotted and it needs to be removed (36589) and inserted (36558) later. All of the notes are in the same format for post-op pts as they are reported for pts who don't have sx -- objective, vitals, ROS, assessment/plan, etc. The subsequent hospital visits are always getting bundled to the sx but I'm unsure if the consults automatically constitute a follow up from the sx. Either way post-op pts are being treated just as other pts are with unproblematic CKD. What do I do with this?

 

[dtricia]

E/M bundling

What I know is the the E/M must very clearly be a separately identifiable service from the procedure performed. Procedures have some evaluation inherent in the code. If the visit does not require a work up, it may not warrant an E/M. A routine evaulation to assure no issues prior to dialysis may not be separately paid/should not be billed.
I bill for Oncology and if the cancer itself is not evaulated , we do not bill E/M on same day as chemo. Chemo side effect management is inherent in the admin of chemo.There should be evaulation and management of the disease process to bill E/M. I t seems like evaluating labs and vitals for dialysis would be bundled/inherent.
Tricia D