Wiki Reporting an E/M in lieu of minor procedure.

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stephanie7480

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I am looking for guidance please. Is it the discretion of the provider to report an E/M in lieu of minor procedure. I need something official-like to serve as a solid reference either way.
I am bombarded with information about reporting minor procedure with an e/m when I try to search "in lieu of" but that is not what I need.
If anyone can assist I would greatly appreciate it.
 
The details are really not relevant as I do not need specifics regarding this particular encounter. I am just seeking an official position, preferably from CMS so that I may refrence it when commenting guidence to the physicain.
 
Stephanie, I would recommend looking at NCCI. In the general information section about how/why physicians need to report service correctly.
Will that help you?
 
You can try the introduction in the CPT book published by the AMA.

Instructions for use of the CPT Codebook.
Select the name of the procedure or service that accurately identifies the service performed.

It goes on to say that it cant be an approximation and to bill unlisted code if necessary. Also to properly document the medical record what was performed

Reading between the lines, I'm assuming the physician is suggesting billing an E&M instead of the service performed to get around coverage restrictions, medical necessity, etc? I can understand why you wouldn't want to be specific.
 
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