Wiki E/M with debridement, only 1 diagnosis

[SBilb89]

Hello, I am second-guessing myself here when it comes to E/M with 97597, 11042, etc. If the ulcer is debrided, and the provider also puts in a referral for home health and a referral for an ABI test, is that enough to qualify for a separate E/M

I know per AMA guidelines the diagnoses don't have to be different, but I'm not sure exactly what it takes to be significant and separate enough when there is only one diagnosis. I don't believe ordering these tests is considered "standard" in debridement as not every patient requires it.

Thanks in advance!

 

[jkyles]

Hi there, I recommend the strike out test: If you delete everything related to the procedure or procedures from the note, is what's left enough to qualify for an E/M visit? If it is not, you wouldn't report the E/M visit. If it is and the documentation meets the full descriptor for modifier 25, you should be OK to report the E/M.