Wiki E/M with pain mgmt procedure

[Melissa*Ever*Evolving]

Hello,
My doctor is inquiring if the following would allow 99202 to be billable with a procedure done the same day:

The patient is seen for the first time (referred to him) and talks things over before doing a procedure on the same day.

He is insisting this should be billable. I do not see how the -25 modifier applies in this case since 99202 already states this is a new pt, covering the additional work up for that.

I need info to support this asap.
Please help!

Thank you!

~Melissa, CPC

 

[nyyankees]

Hello,
My doctor is inquiring if the following would allow 99202 to be billable with a procedure done the same day:

The patient is seen for the first time (referred to him) and talks things over before doing a procedure on the same day.

He is insisting this should be billable. I do not see how the -25 modifier applies in this case since 99202 already states this is a new pt, covering the additional work up for that.

I need info to support this asap.
Please help!

Thank you!

~Melissa, CPC

If you are asking about the 25 modifier I would add it as I know some carriers (UHC, Oxford) want 25 mod on New Patient visits. Also you can bill 99202 + procedure on same date.

 

[mitchellde]

it really depends on the documentation, if the procedure was already planned prior to seeing the patient , then new patient or est, you cannot charge an E&M, since an assessment to determine the need for the procedure has already been performed. The procedure includes as part of its global, the discussion and assessment prior to the procedure. The E&M is billable only if it is significant and separately identifiable from the reason/need for the procedure.