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Re: E&M Coding with Procedures

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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 1 of 5 , Apr 26, 2013
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      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]
      > > >
      > >
      >
      >
      >
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