Wiki E/M Level with a Procedure

[Brandilyn]

I needing proof and resources with a problem that was brought to me to look into. Our facility has always charged a level with a procedure and added a -25 modifier to the level.

Example:

Patient comes in with laceration to arm, phys does simple repair, documentation is there to give a E/M level 3 and also the procedure.

Should we only be charging for the procedure?

I was told that if the ONLY WAY to chg both a level adn procedure is if : Example:
phys treated the laceration and the patient also had a cold (but this was not the reason for the visit) and the phys provided med for the cold then I could give the E/M and the procedure. But ONLY if the phys had gone "above and beyond" (cpt guidelines).

HELP WOULD BE APPRECIATED!! NEED TO TAKE THIS TO SUPERVISER!!

 

[sgoodknight]

Please do not confuse 25 & 57. Modifier 57 means the decision for surgery. Modifier 25 does NOT.

Without seeing notes there is no way to determine if the office visit was medically necessary above and beyond what was required to make the decision to suture the laceration.

Sandy Goodknight, CPC, CPMA, CEMC
Indiana

 

[Brandilyn]

This is in an emergency room setting!! Thanks!

 

[eadun2000]

I needing proof and resources with a problem that was brought to me to look into. Our facility has always charged a level with a procedure and added a -25 modifier to the level.

Example:

Patient comes in with laceration to arm, phys does simple repair, documentation is there to give a E/M level 3 and also the procedure.

Should we only be charging for the procedure?

I was told that if the ONLY WAY to chg both a level adn procedure is if : Example:
phys treated the laceration and the patient also had a cold (but this was not the reason for the visit) and the phys provided med for the cold then I could give the E/M and the procedure. But ONLY if the phys had gone "above and beyond" (cpt guidelines).

HELP WOULD BE APPRECIATED!! NEED TO TAKE THIS TO SUPERVISER!!

Of course you do in the ER. ER patients are considered new patient, new problem. You would code the visit and the procedure both for professional AND facility.