Trying to find the right documentation with Medicare for this...does anyone bill for and office visit and the bone density scan done on the same day in an office setting and if so, what is the criteria that has to be met to do so? I know on certain procedures it would depend on the documentation and a 25 modifier. Looking for some guidance or the link for sure on where to find that especially through CMS.
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Wiki E&M and Bone Density in office
- Thread starter nbohm
- Start date
mitchellde
True Blue
if the scan was the reason for the encounter then you cannot bill the E&M, the documentation you seek is within the definition of the 25 modifier and proper use. Your assessment of the patient( the E&M) must be distinct and separately identifiable form the procedure/test performed. Meaning the E&M must be for reasons over above and beyond the procedure/test performed. If the procedure/test is scheduled as the reason for the encounter then the medical necessity for the procedure/test has already been determined at a previous encounter. Every procedure has as a part of the procedure/test, the assessment of the patient needed to successfully execute.