Wiki E&M and Cysto..Modifier 25 or not..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?
__________________
Keshia Peters, CPC

 

[Anastasia]

You're right

 

[shreesailam99@gmail.com]

code only procedure

jst code with procedure as it was estalished condion.......again no need to give e/m

 

[skiboi]

I am struggling trying to explain the same thing to my internal medicine providers. The latest is that Pt comes in previously for pain in shoulder, E/M billed originally with first complaint plus 20610. Pt comes back again for pain in shoulder he tries to bill E/M 99213 plus the 20610. He thinks he's justified to bill and E/M with EVERY encounter. He TOTALLY does not get that the E/M is bundled into the procedure.

I have explained the proper use of the 25 modifier, explained repeatedly that the E/M has to cover something separate. He still believes that his way, is correct. This is after my lead and I sat before the entire IM provider staff meeting along with their directors and explained this all to them and warned them of the red flags this sends up due to the overuse of the 25 modifier.
Now we have administration telling the whole staff that they NEED to maximize every encounter, totally contradicting what were educating them on.
This is also coming from the same provider who thinks that whoever performs the RAC audit, they need to prove HE is wrong. argghhhh I hope he never has to find out the hard way.
Good luck to all who have to explain/educate on this subject, it's like beating a dead horse. Sorry I'm kind of venting on this subject as you might be able to tell. But I agree that the E/M with the cysto is not billable, again the E/M that he needs to do is covered in the Px itself.