That MM is the medicare or CMSD web site and it is a teaching tool or information tool they use. Is that what you are asking?
--- In MedicalBillers@yahoogroups.com, "Melinda" <melindadocsmith@...> wrote:
> Does 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
> know about
> 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
> should try
> to find the CR or MM, if it exists.
> Melinda Brown, CMBS
> Ins Biller
> "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
> billed. This
> 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
> the skin
> 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
> E&M can
> 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
> Athena and
> 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."
> [Non-text portions of this message have been removed]