Practice Management

Hi All! I recently learned that some IR's are billing an E/M code along with the code for the procedure.

Per CMS rules, every procedure

includes an "inherent" E/M component so you may not report a separate E/M service on the same date of service.

To those of you who are billing an E/M code along with the IR procedure,

are you doing the E/M on the same day as the procedure?  

Heidi,

I have posed your question to one of our senior coders who has responded as follows: 

It can be appropriate to code/bill for an E/M service on the same date as an intervention.  The E/M must be a separately, identifiable procedure, not just a history and physical prior to a scheduled intervention.  For example, if a patient presents for a liver biopsy and the provider sees the patient prior to the biopsy, explains the procedure and has the consent signed, it is not a separately billable procedure.

However, if the patient presents for evaluation of elevated liver enzymes and management recommendations this would be a billable service even if there is an intervention on the same date of service.  The E/M encounter led to the treatment decision.

It's a fine line between the two and a lot depends on the documentation in the report.

Hi All! I recently learned that some IR's are billing an E/M code along with the code for the procedure.

Per CMS rules, every procedure

includes an "inherent" E/M component so you may not report a separate E/M service on the same date of service.

To those of you who are billing an E/M code along with the IR procedure,

are you doing the E/M on the same day as the procedure?  

Hi All! I recently learned that some IR's are billing an E/M code along with the code for the procedure.

Per CMS rules, every procedure

includes an "inherent" E/M component so you may not report a separate E/M service on the same date of service.

To those of you who are billing an E/M code along with the IR procedure,

are you doing the E/M on the same day as the procedure?  

Both the medically necessary E/M service and the procedure must be appropriately documented by the physician/practitioner in the patient's medical record to support claims for payment and procedure, and this documentation must be available if requested by the carrier.

The 25 modifier should designate a significant, separately identifiable E/M service provided by the same physician/practitioner to the same patient on the same day as another procedure or service. 

The 25 modifier identifies a significant, separately identifiable E/M service. It should only be applied when the E/M service is above and beyond the usual pre- and postoperative work of a procedure with a same-day or 10-day global fee period performed on the same day as the E/M service.

Different diagnoses are not required to report the E/M service on the same date as the procedure or other service. Still, the best practice is always to code notes to the highest specificity to ensure timely reimbursement from the payer.

The physician documentation needs to reflect a significant and separately identifiable problem, a problem-focused history, an exam, and medical decision-making of low complexity to support the 25 modified E/M services. 

Unless the patient experiences a significant worsening of symptoms or a new complaint that requires a separate evaluation, another E/M service is not billable or warranted. Remember: the physician or physician extender has already evaluated the patient for the same complaint during the earlier E/M visit. The provider may perform a courtesy exam immediately before the procedure, but such an evaluation is insignificant in supporting a separate "stand-alone" note.  

Candice Chandler CPC, CEMC

StreamlineMD Coding Manager 

111 Stow Avenue Ste 106 | Cuyahoga Falls, Ohio  44221
( 801-520-4049  | * cchandler@streamlinemd.com

Hi All! I recently learned that some IR's are billing an E/M code along with the code for the procedure.

Per CMS rules, every procedure

includes an "inherent" E/M component so you may not report a separate E/M service on the same date of service.

To those of you who are billing an E/M code along with the IR procedure,

are you doing the E/M on the same day as the procedure?