Can anyone share with me their thoughts on coding laceration repairs please. I work in an urgent care and there is question as whether to code an E/M with a simple, intermediate or complex laceration repair. I would think that if there are no other signs or symptoms involving the laceration repair and it is a simple repair that we would only bill the repair (whether it be dermabond or sutures) however if the laceration happened due to a fall, accident, etc. then of course we would do a work up on the patient and bill the proper E/M along with a -25 modifier. I would greatly appreciate some feed back, thank you.
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Wiki Coding laceration repairs with an E/M code
- Thread starter Its Bri
- Start date
Pathos
True Blue
Hello,
Don't forget that every single procedure code always includes a minor E/M bundled into the code. This means a small History, tiny Exam and a quick MDM.
In order to bill an actual E/M visit on top of a procedure, and applying modifier 25 (M25), let's look at M25 description:"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service".
The keywords are "Significant and Separate"; meaning if the rest of the E/M note is closely associated with the procedure, you would be hard pressed defending both the E/M and a procedure in a possible future audit, as the E/M is usually bundled into the procedure.
In the example given, I do not see the visit qualify for both the procedure and an E/M visit. Apart from the procedure description, there should be a slight E/M included in the note as well. This E/M could explain how the laceration happened (HPI), along with a small Exam, and MDM explaining briefly the procedure and aftercare.
Good question! When I get unsure about guidelines, I like to take a proverbial step back, way back to the basics and see if I missed anything.
Hope this helps you!
Don't forget that every single procedure code always includes a minor E/M bundled into the code. This means a small History, tiny Exam and a quick MDM.
In order to bill an actual E/M visit on top of a procedure, and applying modifier 25 (M25), let's look at M25 description:"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service".
The keywords are "Significant and Separate"; meaning if the rest of the E/M note is closely associated with the procedure, you would be hard pressed defending both the E/M and a procedure in a possible future audit, as the E/M is usually bundled into the procedure.
In the example given, I do not see the visit qualify for both the procedure and an E/M visit. Apart from the procedure description, there should be a slight E/M included in the note as well. This E/M could explain how the laceration happened (HPI), along with a small Exam, and MDM explaining briefly the procedure and aftercare.
Good question! When I get unsure about guidelines, I like to take a proverbial step back, way back to the basics and see if I missed anything.
Hope this helps you!
CodingKing
True Blue
A good example from the NCCI Manual