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Podiatry wound care coding question

Hattiesburg Posted Thu 27th of October, 2016 11:49:26 AM
Do you know of a good resource that we could use to help us determine if an E/M with 25 modifier can be billed on the same day as a debridement (97597)? (what would need to be documented to make it a separate and identifiable visit)
SuperCoder Answered Fri 28th of October, 2016 03:28:31 AM

Billing of an E&M code with a procedure code depends on the global day indicator of that code. Global day indicator of CPT code 97597 is 000 which means endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount, evaluation and management services on the day of the procedure generally not payable. Hence E&M code is not payable service with this code.

E&M code can only be paid along with this CPT code in the below mentioned scenario:

If the evaluation and management is being performed for a problem other than the current problem (NEW problem), then appropriate E&M code can be billed with 25 modifier to confirm seperate identifiable evaluation and management service. 


Hattiesburg Posted Fri 28th of October, 2016 09:40:20 AM
I agree with the above but should there be a significant improvement , decline or change in the patients condition or functional status that was not anticipated in the plan of care, wouldn't it be appropriate to bill the correct level E/M with the 25 modifier? but with just a change in the type of dressing used on a wound would not be considered a change of plan of care?
SuperCoder Answered Tue 01st of November, 2016 09:26:47 AM


You cannot bill the E&M code on the same day of procedure. Since the global day of this code is 0, you can bill for the appropriate E&M code next day/next visit as per the coding guidelines. Had it been a 10 day global day procedure code, E&M code would get paid only after 10 days, once the global days of the procedure code is over.  

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