5848Re: E&M Coding with Procedures
- Apr 25, 2013We'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
--- 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?
> --- 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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