Wiki E/M Billing Question

ywilliamsCPC

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The group I work for always bill an E/M code (99201-25) to all imaging (MRI, CT, etc) and OP dental cases. My new manager is questioning if this is appropriate since the E/M is typically inclusive to the base unit of the ASA code and does not feel that the 25 modifier is appropriate. The only thing I could find was that if a case cancelled the anesthesiologist could then bill for the E/M. Again they only bill this for dental and imaging cases. When is it appropriate to bill E/M for anesthesiologist with the modifier 25?
 
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The 99201 is not separately reportable per the Medicare NCCI Policy Manual.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Anesthesia care is provided by an anesthesia practitioner who may be a physician, a certified registered nurse anesthetist (CRNA) with or without medical direction, or an anesthesia assistant (AA) with medical direction. The anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and postanesthesia recovery care. Preoperative evaluation includes a sufficient history and physical examination so that the risk of adverse reactions can be minimized, alternative approaches to anesthesia planned, and all questions regarding the anesthesia procedure by the patient or family answered. Types of anesthesia include local, regional, epidural, general, moderate conscious sedation, or monitored anesthesia care (MAC). The anesthesia practitioner assumes responsibility for anesthesia and related care rendered in the post-anesthesia recovery period until the patient is released to the surgeon or another physician.

Anesthesia services include, but are not limited to, preoperative evaluation of the patient, administration of anesthetic, other medications, blood, and fluids, monitoring of physiological parameters, and other supportive services.


3. It is standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation prior to surgery. This is considered part of the anesthesia service and is included in the base unit value of the anesthesia code. The evaluation and examination are not reported in the anesthesia time. If surgery is canceled, subsequent to the preoperative evaluation, payment may be allowed to the anesthesiologist for an evaluation and management service and the appropriate E&M code may be reported. (A non-medically directed CRNA may also report an E&M code under these circumstances if permitted by state law.)
 
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