Bernadette10
Guru
Since the provider discussed the procedure before doing it, is this enough to bill a separate 99213? I was thinking no, that it should just be 17000, but I'm doubting myself. I know a similar question has been asked before, but it's still a hard decision.
Patient presents for a new spot on the LT clavicle.
Past Medical History:
Actinic keratoses.
Basal cell carcinoma.
Disease of thyroid gland.
Review of Systems:
General: No fever or chills
Skin: No new rash
Chart reviewed including PMH, social history, family history, allergies, and current medications.
Exam:
General: well developed, well nourished, in no acute distress.
Mood: Pleasant:
Mental Status: Alert and oriented.
Assessment:
AK left clavicle. After a discussion of the procedure, the lesion was treated with liquid nitrogen x2. Patient tolerated well.
The Medicare Claims Processing Manual, Chapter 12, Section 40.1.c, explains:
A visit on the same day could be properly billed in addition to suturing a scalp wound if a full neurological examination is made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status.
Patient presents for a new spot on the LT clavicle.
Past Medical History:
Actinic keratoses.
Basal cell carcinoma.
Disease of thyroid gland.
Review of Systems:
General: No fever or chills
Skin: No new rash
Chart reviewed including PMH, social history, family history, allergies, and current medications.
Exam:
General: well developed, well nourished, in no acute distress.
Mood: Pleasant:
Mental Status: Alert and oriented.
Assessment:
AK left clavicle. After a discussion of the procedure, the lesion was treated with liquid nitrogen x2. Patient tolerated well.
https://www.aapc.com/blog/27690-know-when-to-bill-em-with-a-minor-procedure/
The Visit’s Purpose Can Help You Decide
Even if the E/M service is related to the minor procedure, you still may be able to report it separately. Ask yourself: Did the E/M occur because of the procedure, or was the need to perform a minor procedure determined as a result of a significant (i.e., fully supported by documentation and includes the key elements of history, exam, and medical decision making (MDM)) E/M service? Only in the second case may you report the E/M in addition to the procedure.The Medicare Claims Processing Manual, Chapter 12, Section 40.1.c, explains:
A visit on the same day could be properly billed in addition to suturing a scalp wound if a full neurological examination is made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status.