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Re: E&M Coding with Procedures

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  • 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 1 of 5 , Apr 24, 2013
      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 2 of 5 , Apr 25, 2013
        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 3 of 5 , Apr 25, 2013
          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 4 of 5 , Apr 26, 2013
            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
            Messages
            > in this topic (3)
            >
            > Recent Activity:
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            >
            >
            > ________________________________
            >
            >
            > Switch to: Text-Only, Daily Digest • Unsubscribe • Terms
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            > Feedback
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