Wiki New Patient w/FB removal

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cmmfeyen

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If a new patient comes in solely for the purpose of having a FB removal done, and the ophthalmologist does a new patient exam and then removes the foreign body (piece of metal), should we be charging a new level plus a FB removal. I was under the impression that there is an E/M level included in the procedure charge and that unless the patient came in for an exam and then also had some sort of procedure done, we should only be charging the procedure. My ophthalmologist is saying that because it's a new patient, he has to do an exam before even trying to remove anything form the patient's eye, just in case. Help!!!
 
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Personally, I believe the doctor handled this improperly. The patient's CC was a FB and came in specifically for that to be removed, I'm assuming because they knew for certain that they'd gotten something in their eye. That should have generated a problem focused exam for that problem and the doctor should have had the patient come back another day for the new patient exam. Basically, what the doctor is telling is that the patient knew they had a FB and the doctor made them suffer through a comprehensive exam before they would remove the FB when all they had to do was check for the FB and any sign it may have penetrated the eye and then remove the FB.

You are correct that, in general, if a patient comes in with a CC of FB, there is an E/M element to evaluate for the FB included in the FB removal fee. It would have been different if the pt came in for a comprehensive exam, not aware they had a FB, and the doctor found a FB while doing the exam. Then you would be justified in billing for the exam with a 25 modifier and then billing for the FB removal.

Tom Cheezum, OD, CPC, COPC
 
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