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E&M

Eunice Posted Tue 06th of November, 2012 14:16:26 PM

I am working on indpendent diangostic facility and one of our radiologist is starting pain injection.
Prior to injection, our radiologist is spending upto 30 minutes evaluating patient.
Can I bill both E/M procedures and pain injection on same date?

Thank you!

SuperCoder Answered Tue 06th of November, 2012 14:44:32 PM

Do not automatically bill an E&M with pain injection. If the E&M is the significant separate service, the E&M and the injection are both reportable. If the E&M is not the significant service or is not performed for a separate problem/diagnosis, the E&M is most likely not separately reportable. Many payors will bundle E/M visits and minor procedures and include the E&M in the surgical procedure. If radiologist spent time for another problem and after that decided to give pain injection, then bill injection code and E/M with -25 modifier. Medical necessity should justify and support to bill both with the different problem, dx regarding injection and prior evaluation.

Eunice Posted Tue 06th of November, 2012 22:06:45 PM

Thank you but I have additional questions.

Do we need have separate script from referring physician for E/M?

if our radiologist wants patient to come to facility prior to the date of pain injection to go over history and medical information, will this support billing E/M?

if patient decide not to have exam done after our radiologist evaluate patient's history and medical information, then can we bill E/M?

Thank you!

SuperCoder Answered Wed 07th of November, 2012 10:17:41 AM

1) Yes, separate script should be needed from referring physician.
2) If it's related to injection, then it cannot support for E/M. If it’s some other condition, unrelated to pain injection, then can support for E/M.
3) Without exam, you can't bill E/M. To bill a particular E/M level, hx, exam, and MDM, these key components are necessary for a new patient and any of two key components should require for established patient.
******
If you are going to code for a particular level of E/M based upon timing, then you need to follow these important points.
1) If it’s counseling and coordination of care, then you can go for time based coding. Even though time is not one of the three key components, but it can become the determinant for CPT code selection when the visit consists predominantly of counseling or coordination of care.
2) The total time must be spent face-to-face between the physician (or NPP) and the patient; more than half of that time must be spent counseling or coordinating care, and the content of those activities should be summarized. Time spent reviewing records while the provider is not with the patient does not qualify. Time should be rounded down, not up.

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