Wiki E/M and Cystoscopy

[lgiusti]

Trying to establish some criteria for billing an E/M service and Cystoscopy same day. If patient has already been seen and Cystoscopy scheduled under what circumstances would you bill an EM? I am thinking if the provider found a suspicious lesion and is taking the patient to the OR for further study and has explained the risks and benefits a separately identifiable E/M -25 would be appropriate. I welcome all feedback.

As always, thanks
Lyn CPC

 

[Pam Warren]

If the patient was previously scheduled for the cystoscopy, you would only bill the cystoscopy. The only time you'd bill an additional E&M is if in the interim an entirely different problem or an extreme exacerbation of the current problem occurred, causing the need for the provider to complete a separate and significant workup. In your example with the new lesion requiring additional workup and decision making, (and a different diag probably), then you could report the E&M with the -25 modifier. I've attached a decision tree that we use. Hope this helps.

 

[lgiusti]

E/M w/Cysto

Thank you so much Pam for your quick response. The decision tree is very helpful.

All my best,
Lyn