Wiki E/M coding with procedure coding

[Astewart1]

Hi, first time forum poster so bare with me.
I code for a Dermatology Clinic and I have a P.A. that was previously a GP provider and brand new to Derm. She is making me question myself. So the scenario is she saw a New Patient with 22 year history of Psoriasis, uncontrolled. She did a very detailed HPI, ROS even pulled in another Dr. that works in the clinic. She then did 2 Tangential skin biopsies (one on each leg) and doesn't understand why I didn't give her an E/M code as well. Am I wrong can I bill an E/M also?

 

[shanamarie]

Hi, first time forum poster so bare with me.
I code for a Dermatology Clinic and I have a P.A. that was previously a GP provider and brand new to Derm. She is making me question myself. So the scenario is she saw a New Patient with 22 year history of Psoriasis, uncontrolled. She did a very detailed HPI, ROS even pulled in another Dr. that works in the clinic. She then did 2 Tangential skin biopsies (one on each leg) and doesn't understand why I didn't give her an E/M code as well. Am I wrong can I bill an E/M also?

I’m not familiar with dermatology, but in this case the patient is new to the clinic, so the provider had to evaluate the patient first to determine treatment options and then performed the biopsy. If that is the case then I would think the e/m visit seems appropriate in addition to the biopsy.

If the patient was scheduled to come in for the biopsy (it was planned) then I would think the e/m may not be medically necessary depending on the situation.

 

[Astewart1]

I’m not familiar with dermatology, but in this case the patient is new to the clinic, so the provider had to evaluate the patient first to determine treatment options and then performed the biopsy. If that is the case then I would think the e/m visit seems appropriate in addition to the biopsy.

If the patient was scheduled to come in for the biopsy (it was planned) then I would think the e/m may not be medically necessary depending on the situation.

Thank you!

 

[arozance27]

That is not correct.
If there is a not a significant and separately identifiable problem assessed, a separate E/M is not billable. The pre-op workup is included in the biopsy CPT.

Referencing the National Correct Coding Initiative Policy Manual for Medicare service:
E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.

 

[Astewart1]

That is not correct.
If there is a not a significant and separately identifiable problem assessed, a separate E/M is not billable. The pre-op workup is included in the biopsy CPT.

Referencing the National Correct Coding Initiative Policy Manual for Medicare service:
E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.

I did not end up billing an E/M and after several discussions and multiple print outs I think she understands this now. Thank you for your feed back. Much appreciated.