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Re: [MedicalBillers] Re: E&M Coding with Procedures

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  • debbie brosnan
    No I havent..  Anxiously waiting to see if anyone else finds anything.  Deb ________________________________ From: Melinda To:
    Message 1 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 2 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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