Wiki E&M and Cysto....Help

[kpeters88]

I understand that a provider should not bill a separate E&M code unless the E&M is unrelated. I am also aware that procedures that were planned in a previous visit during which the patient had an initial work up for the decision to plan the procedure qualify as the E&M workup and the E&M is not to be charged again on the day of the procedure.

My physician is convinced that we can charge for an E&M in two cases where the coders have disagreed:

CASE 1: First visit, initial consult - dx - urgency of urination, incontinence, hematuria, abdominal pain. PX - E&M, cath, UA. Plan - schedule cysto in 2 to 3 weeks, no meds want to try bladder retraining first, bladder retraining.

2 to 3 weeks later patient comes in for cysto - dx still hematuria, abdominal pain, incontinence, and urgency of urination. Px - cysto and E&M. Plan bladder retraining continue, prescribe meds, follow up in 1 month.

Can the cysto and E&M be charged together for the follow up even though the cysto was planned because the physician changed the plan by adding medications?
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Keshia Peters, CPC

 

[Kevinph84]

If the provider scheduled the cystoscope to be performed, I would then consider it the only billable service. If the provider changed his plan of treatment, than maybe you can argue an E&M. Overall, it has to be seperately identifiable. That is just my opinion.

For example, the provider saw the patient and performed the cystoscopy. Upon arrival, the medication was causing an allergic reaction and/ or has an onset of new symptoms. At this point the provider then performs a distinct physical examination, prescription drug management by changing medication, etc. That I feel is when a seperate E/M code can be reported.