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5848Re: E&M Coding with Procedures

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  • Melinda
    Apr 25, 2013
    • 0 Attachment
      We're trying to figure out where the information came from that the "home office" is issuing out. I thought it was weird they didn't give a CR or MM number. Just wondering if anyone else had read anthing recently about it. They made it sound as if it was a new policy.

      Melinda Brown, CMBS
      Ins Biller

      --- In MedicalBillers@yahoogroups.com, "djgeisel" <djgeisel@...> wrote:
      >
      > 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?
      > Diana
      >
      > --- In MedicalBillers@yahoogroups.com, "Melinda" <melindadocsmith@> wrote:
      > >
      > > Does anyone know where this source might be from? A CMS MedLearn Matters
      > > (MM),
      > > 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 -
      > > http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/c\
      > > lm104c12\
      > > .pdf
      > > <http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/\
      > > clm104c12.pdf>
      > >
      > > The wording below is from the clinic home office. I'm trying to discover
      > > the
      > > validity vs hearsay. I did tell the local office OM that she really
      > > should try
      > > to find the CR or MM, if it exists.
      > >
      > > Thanks!
      > > Melinda Brown, CMBS
      > > Ins Biller
      > >
      > > "Medicare has issued a notice about a change in how providers must bill
      > > for
      > > procedures that are performed at the same visit as an E&M code. Medicare
      > > will
      > > no longer allow providers to bill for the E&M, whether for a new or
      > > established
      > > 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
      > > procedure
      > > at the same visit, only the procedure can be billed. If other problems
      > > are
      > > 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
      > > been
      > > verified by our CHS coding experts. Our business office and coders have
      > > been
      > > educated on this change.
      > >
      > > Examples:
      > > 1. A primary care provider evaluates a patient for a cough, documents an
      > > appropriate E&M service, prescribes medication, and gives instruction on
      > > home
      > > 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
      > > for
      > > the evaluation of the cough with a 24 modifier, and bill separately for
      > > the skin
      > > biopsy.
      > >
      > > 2. An orthopedist sees a patient for a consultation about a painful knee
      > > and
      > > decides to inject the knee at that visit. The only problem the doctor
      > > addresses
      > > is the knee. Only the injection can be billed, not the office visit E&M.
      > > The
      > > payment for the injection covers the evaluation that resulted in the
      > > injection.
      > >
      > > 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
      > > laceration
      > > repair can be billed as a procedure. But, if the only evaluation was for
      > > the
      > > laceration without doing an evaluation for the closed head injury, only
      > > the
      > > laceration repair would have been billed.
      > >
      > > This is only for Medicare so far. We think other payers will continue to
      > > pay
      > > 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
      > > for
      > > Medicare when necessary. Please contact your coder if you have
      > > additional
      > > questions about this change."
      > >
      > >
      > >
      > >
      > > [Non-text portions of this message have been removed]
      > >
      >
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