brockorama01,
Yes, the documentation has to support the E&M or consult. I realize in the chronic pain arena that your referrals may more easily qualify as a consultation, however, I'm also saying that just because a minor procedure is being performed on a new or existing patient it doesn't warrant an E&M or consultation charge in addition to the procedure . By adding the -25 modifier it is signifying a separately identifiable procedure. See the below excerpt from NCCI Chapter 1 pages 12/13.
"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits. Neither the NCCI nor Carriers (A/B MACs processing practitioner service claims) have all possible edits based on these principles."
Julie, CPC