Let's say you see a patient for endometrial cancer C54.1. Typical treatment is a hysterectomy, but she is a young patient who wishes to preserve her fertility at this time. You perform an endometrial biopsy, 58100. In addition, you discuss the stage and progression of her cancer, renew prescription Megace, discuss additional treatment options such as radiation and/or chemotherapy. You spend 22 minutes beyond the biopsy discussing the above. All that additional work justifies -25 on an E/M, but will have the same diagnosis as the biopsy.
I recommend this when trying to determine if an E/M -25 is appropriate with a procedure:
Eliminate everything in the note that is part of the work of the procedure. What do you have left? Is it significant? If so, then E/M with -25 may be appropriate, regardless of a different diagnosis.