Wiki E/M instead of Cast Removal?

[Diana2032]

Good morning,

If my provider places a cast and the patient returns within a week or so for cast removal; can my provider bill for an E/M? I know that the removal of the cast is inclusive because he placed the cast, but I feel like he should be able to bill for the E/M when the pt returns because to determine that the pt needs no further treatment he needs to evaluated the pt thus an E/M is separately reportable. Thoughts?

 

[Pam Warren]

So you're billing an E&M code instead of a scheduled cast removal code, (which was what took place), just to get paid?

 

[Orthocoderpgu]

I agree with Pam. Especially if this is a "scheduled" or planned cast removal. If all that is being performed is a scheduled cast removal, an E/M of any kind would not be supported. Remember that medical necessity is the foundation for any code being billed. And any billable E/M should have supported History, Exam & MDM. Medical necessity should support all three key components.