Wiki Small E/M included in 17110?

[susansipe]

So, is this true? Charging a Level 1/2 OV with a 17110 and the OV denies. We are being told "there is a small e/m in any procedure".

Thanks!
Sue

 

[scadykat]

The CPT Surgical Package Definition clearly states: "In defining specific services "included" in a given CPT surgical code, the following services are always included in addition to the operation per se: Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or ON the date of procedure (including history and physical)."

 

[tg]

You may want to check out this article (it is dated 2004 but our point probably still stands):

http://www.aafp.org/fpm/2004/1000/p21.html

They give the following example:

"The patient complains of a troublesome lesion, you evaluate the lesion and you remove it at that visit. The surgical code includes the evaluation services necessary before the performance of the procedure, so no E/M code should be billed."

 

[AprilSueMadison]

From Medicare NCCI guidelines..

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is ?new? to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI contains many, but not all, possible edits based on these principles.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological an E&M service may be separately reportable.

Your doctor has to go above and beyond the normal work for a destruction to qualify for an E/M visit.

From the American Academy of Derm...the normal work for a destruction includes the following:

Pre-service (before the destruction is done) work: includes a review of pertinent medical records data, a discussion of treatment choices, a review of risks of the treatment with the patient, obtaining informed consent, and preparation of necessary equipment.

Intra-service work: inspection and palpation of lesions to establish a diagnosis and to specify size, location, depth, and then the actual destruction with liquid nitrogen freezing.

Post-service work: application of any antibiotic ointment and dressings, if needed, and post-procedure patient and family instructions. Charting and any communication with a referring physician are included in this work.