Wiki Procedures including E&M?

[susansipe]

I have been getting info from my main billing office that procedures include a basic E&M evaluation of the problem.

For the past 4 yrs I have been under the protocol that if pt comes back in less than 30 days for a procedure that was previously addressed, that we do NOT include an E&M. But if over 30 days, we include an E&M because the provider has to reassess the whole situation.

But now, as stated first, our billing office says SOME procedures include the E&M and I cannot bill for it at the visit, no matter the timing.

We even showed them the recent article in the magazine, but I guess the insurance aren't agreeing?

Thoughts?

 

[AlaskanCoder]

All procedures with a 0/10/90 day global period include pre- and post- procedural work which constitutes an E/M service. In determining the relative value units of a CPT code, for instance, there are certain services that are considered integral to any service and the work involved in these services is considered in the reimbursement and is not separately reportable. You can only bill for an E/M service is the E/M service is significantly more than the normal pre- and post- procedural work for that service. The fact that it is 30 days or more since the procedure was first addressed does not support the need for a separately identifiable E/M in these services. Here is a quote from CPT Assistant about the pre/post procedural work included in procedures with a 0/10/90 global period:
?The CPT? codes for procedures do include the evaluation services necessary prior to the performance of the procedure (eg. assessing the site/condition of the problem area, explaining the procedures . . . discussion of probable diagnoses . . . [explaining] risks and benefits . . . expected result or scar . . . obtaining informed consent) . . . instruction of the patient/family on postoperative wound care, dressing changes and follow-up, instructions given to the patient on how to recognize significant complications (eg. bleeding, or allergic reaction to antibiotic ointment or adhesive dressing), when results will be available and how they will be communicated, completion of medical records, and communication of results to referring physicians, as appropriate . . . ?
(CPT? Assistant 9/98)
Hope this helps.

Karen Hill, CPC, CPB, CPMA

 

[cynthiabrown]

I agree with Karen.............many offices are under the impression an E/M is seperately reportable with a procedure. This is why modifer 25 has been a red flag ...........to be used for significate, seperate service only

 

[susansipe]

thanks Karen and Cynthia...

However, where do I find out if a procedure has a global? I feel stupid asking this, like I should know...but I am drawing a blank on this.

 

[mhstrauss]

thanks Karen and Cynthia...

However, where do I find out if a procedure has a global? I feel stupid asking this, like I should know...but I am drawing a blank on this.

Some coding programs have this included, as well as some "specialty" books...Coding Companion for one. But the info comes from the CMS RVU files; here is a link to it, click on the "RVU12A" under downloads, and there are several formats, instructions, and lots of other good info.

http://www.cms.gov/Medicare/Medicar...ed/PFS-Relative-Value-Files-Items/RVU14A.html

HTH!