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Re: Billing questionFrom: Henry Gregor (henrygregor@yahoo.com)Tue May 6 21:32:04 2008
Modifier -25 (Sigificant,separatelly identifiable E/M Service by the same physician n the Same Day of the Procedure of Other Service). For example, your scenario, or, a patient sees her physcian for vulvar pain and a Bartholin's abscess is diagnosed. If the physician performs an I&D, document the evaluation and diagnosis process separately, generally by creating a standard evaluation and diagnosis documentation note, followed by a separate procedure note. Then report, using the E/M code with a -25 modifier. Be prepared to do persistent battle with the insuror. Some will cooperate, most won't. (I guess they depend on most providers and their billing staff to roll over, and move on to something else, like playing the float on their delayed payments.) Keep a careful data base of those who do, those who don't...eventually, you can spare yourself the agony of wasting time on those carriers who won't honor the modifier. I have found most patients are sympathetic to the analogy that if you go the supermarket and buy eggs and butter its reasonable for the store manager to want to be paid for both products and not just for the eggs. I have found most patients will come back on another day to have the procedure done, though, of course, for a symptomatic issue like the Bartholin's cyst, that may be too burdensome and you and the patient will probably want to do what needs doing then and there.Keep a handy printed reference to give the patient to send to her state insurance commissioner for consumer complaint if her carrier fails payment and the burden falls upon her. "Garry E. Siegel, M.D." <garrys@mindspring.com> wrote: If during the course of your evaluation, you determine the need for a procedure (an endometrial biopsy comes to mind), then you can bill the E/M AND the procedure, with a modifier, I think. Lots of luck collecting on it, however. That said, if someone came in for contraceptive counseling, and you decided to put in an IUD, I bet that you could code it similarly with the best of luck collecting. Garry
At Tue, 6 May 2008, Lynn Montgomery wrote:
>
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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