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visit and procedure same day

Super Posted Wed 03rd of November, 2010 18:52:16 PM

I have received conflicting information on guidelines regarding billing for a E&M code along with a procedure done on the same day if the reason for visit is directly related to the procedure performed such as an I&D, wart destruction, nursemaid's elbow.
The procedure can't be performed without evaluation of the patient, I would like to be paid for both but not clear on the guidelines. I do not want to throw up any red flags but I also want to be paid for all services performed. Does anyone have suggestions?

Renee Answered Fri 05th of November, 2010 14:42:49 PM

bill office visit code (99212 - 99214) with a 25 modifier along with the procedure code for the procedure. I have had no problems getting paid for these.

Jen Answered Fri 05th of November, 2010 15:19:49 PM

I agree with Renee. When procedure is done with E&M, modify E&M to get paid for both. I too have no problem getting paid for both. Remember to use the CCI edit tool to check the edits. I use it everyday. It has made a big difference in reducing our denials.

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