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Separate E&M code

Bonnie Posted Fri 06th of February, 2015 16:54:54 PM

Hi could you please tell me for the following scenario if a separate E&M code is billable with modifier 25. Also, if you could code and bill for a separate E&M would that separate E&M be coded and billed on the on the date of the physician order or the date that he reviewed the CT scan.
Breast cancer patient is receiving chemotherapy every other week. On 5/1/2014 patient receives chemo and the oncologist orders PET CT for restaging. On 5/15/2014 patient receives chemo and oncologist reviews PET CT (Last CT was done on 3/1/2014). Is a separate E&M billable and on which date of service would you bill it.

SuperCoder Answered Sun 08th of February, 2015 03:14:19 AM

Thanks for your question. A separate E/M is not billable in this instance. You should only bill a separate Evaluation and Management visit if the physician provides a significant and separately identifiable visit in addition to the chemotherapy. From the information that you have provided, it does not appear that the physician saw the patient or actually provided a E/M service outside of the chemotherapy.

Bonnie Posted Sun 08th of February, 2015 09:56:08 AM

The physician did see the patient on both 5/1 and 5/15 did brief H&P and deicision to continue chemo.

SuperCoder Answered Mon 09th of February, 2015 08:39:43 AM

Thanks for clarifying. In that case, if your provider completed an office visit and the documentation will support billing a separate visit, you can bill an E&M code with the appropriate modifier appended.

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