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Re: E&M Coding with Procedures

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  • 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 1 of 5 , Apr 25 9:42 AM
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      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 2 of 5 , Apr 25 10:48 AM
      • 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 3 of 5 , Apr 26 10:02 AM
        • 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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