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Medical decision making

Lori Posted Tue 21st of February, 2012 21:23:36 PM

If a provider bills (and is paid separately) for codes, such as 97010, 97112, 29220, are these factored into the medical decision making for the evaluation and management service? The provider billed 99214-25 with the above codes for the same date of service. I would think that since modifier 25 is appended indicating this is separate and distinct that the additional codes billed would not be taken into consideration for the level of MDM.
Thank you in advance!

SuperCoder Answered Wed 22nd of February, 2012 06:55:18 AM

To report the E/M service with the other surgical procedure requires separate medical necessity, so the risk factor for 97010, 97112 and 29220 would not be considered as a part of MDM for 99214.

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