Re: Billing question
From: Larry Glazerman (l.glazerman@rcn.com)
Tue May 6 23:44:00 2008
ron:
You're right about the "significantly and separately identifiable." I
interpret that, however, to mean that the E&M visit is separately
identifiable from the procedure. when I do them together, I always
document a separate office visit note, and a separate procedures note.
I agree that most insurers will throw out the E&M, but that doesn't
mean it's wrong to bill it that way.
--
Larry R. Glazerman MD
St. Luke's Center for Advanced Gynecologic Care
250 Cetronia Road Suite 305
Allentown PA 18104
glazerl@slhn.org
On May 6, 2008, at 10:48 PM, Ronald Anisworth wrote:
> According to my coding manual, the definition of -25 says:
> "Significant and
> separately identifiable. This phrase is important when reporting an
> E/M
> service provided on the same day as a procedure. Physicians can
> report both
> services only when the E/M service is "significant and separately
> identifiable." The physician must obtain and document a history,
> physical
> examination, and medical decision making at a level sufficient to
> justify
> reporting both an E/M service and the procedure." To my mind, the
> implies
> separate diagnosis codes, how else can the insurer identify them as
> separately identifiable? If the visit was for the decision to perform
> surgery on the same day as the procedure, you could use -57 with the
> same
> code.
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Larry
> Glazerman
> Sent: Tuesday, May 06, 2008 2:47 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Billing question
>
> Ron:
>
> I don't think that's quite true - you can have two separately
> identifiable services related to the SAME ICD9 code. For example, if a
> patient comes in for abnormal bleeding, you get a history, examine
> her, go through decision making, there's an appropriate E&M code. If
> you decide to do an endo biopsy at that visit, it can be billed too,
> using the same ICD9 code, with a -25 modifier. I think the modifier
> actually goes on the E&M code rather than the procedure, but I could
> be wrong.
>
> Larry R. Glazerman MD
> St. Luke's Center for Advanced Gynecologic Care
> 250 Cetronia Road Suite 305
> Allentown PA 18104
> glazerl@slhn.org
>
> On May 6, 2008, at 5:29 PM, Ronald Ainsworth wrote:
>
>> Only if you have separately identifiable services -
>> i.e. ICD9 codes. Then you need to use a 25 modifier,
>> as others have noted.
>>
>> --- Lynn Montgomery <apgar10@thebirthcentermt.com>
>> wrote:
>>
>>> Listers,
>>>
>>> I would like opinions regarding a billing question;
>>> when a patient
>>> presents for an office visit for an IUD insertion or
>>> colposcopy for
>>> example, is one allowed to bill an office visit in
>>> addition to the
>>> actual procedure being performed (i.e. 99203 for
>>> office visit and 58300
>>> for IUD insertion). I have gotten different answers
>>> from various
>>> coders, including ACOG!
>>>
>>> Lynn
>>>
>>> Lynn D. Montgomery, M.D.
>>>
>>> Obstetrics & Gynecology, Maternal-Fetal Medicine
>>>
>>> The Birth Center/Rocky Mountain Women's Health
>>>
>>> 1211 S. Reserve St.
>>>
>>> Missoula, Montana, 59801
>>>
>>> 406-549-0978
>>>
>>> fax 406-549-0987
>>>
>>> e-mail: apgar10@thebirthcentermt.com
>>>
>>
>
