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E&M Coding with Procedures

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  • Melinda
    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
    Message 1 of 5 , Apr 19, 2013
    • 0 Attachment
      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]
    • djgeisel
      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
      Message 2 of 5 , Apr 24, 2013
      • 0 Attachment
        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]
        >
      • Melinda
        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.
        Message 3 of 5 , 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]
          > >
          >
        • debbie brosnan
          No I havent..  Anxiously waiting to see if anyone else finds anything.  Deb ________________________________ From: Melinda To:
          Message 4 of 5 , Apr 25, 2013
          • 0 Attachment
            No I havent..  Anxiously waiting to see if anyone else finds anything. 

            Deb




            ________________________________
            From: Melinda <melindadocsmith@...>
            To: MedicalBillers@yahoogroups.com
            Sent: Thu, April 25, 2013 12:42:41 PM
            Subject: [MedicalBillers] Re: E&M Coding with Procedures

             
            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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          • Melinda
            This was given to me from another coding group. I haven t read it yet. I think this is what your looking for MML for EM Services Guide
            Message 5 of 5 , Apr 26, 2013
            • 0 Attachment
              This was given to me from another coding group. I haven't read it yet.

              I think this is what your looking for MML for EM Services Guide
              https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN\
              /MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf
              <https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-ML\
              N/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf>


              --- In MedicalBillers@yahoogroups.com, debbie brosnan wrote:
              >
              > No I havent.. Anxiously waiting to see if anyone else finds
              anything.Â
              >
              > Deb
              >
              >
              >
              >
              > ________________________________
              > From: Melinda melindadocsmith@...
              > To: MedicalBillers@yahoogroups.com
              > Sent: Thu, April 25, 2013 12:42:41 PM
              > Subject: [MedicalBillers] Re: E&M Coding with Procedures
              >
              > Â
              > 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" 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
              > > > > > > 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]
              > > >
              > >
              >
              >
              >
              > Reply via web post Reply to sender Reply to group Start a New Topic
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              > in this topic (3)
              >
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