Wiki GI doc billing for an E/M on same day as colonoscopy and / or EGD performed

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mcandia

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GI doc is billing for an E/M visit (99213-25) on the same day he performs the colonoscopy and / or EGD's.

He documents a complete E/M stating a chief complaint such as change in bowel habits and does an HPI, extensive PE and MDM.

He mentions in his A/P: Change in bowel habits / miralax, high fiber diet, colonoscopy.

It is not a screening colonoscopy as the patient is symptomatic and it is a non Medicare
patient.

The note appears like a problem oriented E/M.

He is evaluating, managing and treating the condition however, I do not believe the -25 modifier is supported as it is a pre planned / scheduled procedure.

Any thoughts?

Thanks,
Maria
 
Last edited:
mcandia said:
GI doc is billing for an E/M visit (99213-25) on the same day he performs the colonoscopy and / or EGD's.

He documents a complete E/M stating a chief complaint such as change in bowel habits and does an HPI, extensive PE and MDM.

He mentions in his A/P: Change in bowel habits / miralax, high fiber diet, colonoscopy.

It is not a screening colonoscopy as the patient is symptomatic and it is a non Medicare
patient.

The note appears like a problem oriented E/M.

He is evaluating, managing and treating the condition however, I do not believe the -25 modifier is supported as it is a pre planned / scheduled procedure.

Any thoughts?

Thanks,
Maria
Click to expand...

If the decision for surgery was performed that day, use a 57 modifier, instead of the 25. But, if it was pre-planned, then the E/M is global, and should be written off. Hope that helps! ;)
 
E/M same day as EGD or Colo

These are procedures with less than 90 days global so 25 modifier is correct.

Michele Hayes, CPC, CPMA , CEMC, CGIC
 
it would be except these are preplanned so there is no reason to charge the E&M, the medical necessity to perform these procedure was previously determined and the procedure then scheduled. Do not charge for an additional assessment to cover the same ground already charged.
 
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