5846E&M Coding with Procedures
- Apr 19, 2013Does anyone know where this source might be from? A CMS MedLearn Matters
or Change Request (CR)? Another local clinic is asking me if I might
this. Does anyone know the details?
The local clinic OM is being lead towards this:
See 30.6.6 & 30.6.7 & Section 40 -
The wording below is from the clinic home office. I'm trying to discover
validity vs hearsay. I did tell the local office OM that she really
to find the CR or MM, if it exists.
Melinda Brown, CMBS
"Medicare has issued a notice about a change in how providers must bill
procedures that are performed at the same visit as an E&M code. Medicare
no longer allow providers to bill for the E&M, whether for a new or
patient, when a procedure is performed that has a 0-10 day global period
associated with it. If a provider does an evaluation that leads to a
at the same visit, only the procedure can be billed. If other problems
evaluated during the visit that are unrelated to the procedure, a
modifier 24 is
attached to the E&M for the unrelated problems and the E&M can be
information comes from the National Correct Coding Initiative, and has
verified by our CHS coding experts. Our business office and coders have
educated on this change.
1. A primary care provider evaluates a patient for a cough, documents an
appropriate E&M service, prescribes medication, and gives instruction on
treatment. The patient also has a skin lesion that the provider wants to
biopsy, and performs the biopsy during that visit. The provider can bill
the evaluation of the cough with a 24 modifier, and bill separately for
2. An orthopedist sees a patient for a consultation about a painful knee
decides to inject the knee at that visit. The only problem the doctor
is the knee. Only the injection can be billed, not the office visit E&M.
payment for the injection covers the evaluation that resulted in the
3. An urgent care provider sees a patient for a head injury with a head
laceration. The provider evaluates the head injury with appropriate E&M
services, orders a CT scan of the head, and repairs the laceration. An
be billed for the closed head injury with a 24 modifier, and the
repair can be billed as a procedure. But, if the only evaluation was for
laceration without doing an evaluation for the closed head injury, only
laceration repair would have been billed.
This is only for Medicare so far. We think other payers will continue to
for both the E&M and the procedure for the time being. We will have
our coders be on the alert for this situation, and correct the billing
Medicare when necessary. Please contact your coder if you have
questions about this change."
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