Sunday, May 15, 2011

E&M - Minor Procedures & CCI verbiage

Welcome to May.... I am still chin-deep in I-10 CM and I-10 PCS training, (and trying not to drown) but I thought I would share with you some information passed along to me from my associate, Gail Eldridge. She was able to attend a class at the AAPC conference in Long Beach, CA on modifiers. This is the information she shared with me, and in turn, sharing with all of you.... I feel this is really important infornation - especially with the audits from CMS and ancillary payers targeting the mod 25 and 'separately identifiable' and 'medically necessary' criteria. Enjoy !! and many heartfelt thanks to Gail for sharing the knowledge...

Billing E&M service same day as minor procedure

The instructor in the AAPC presentation indicated that payers are using the language from the CCI edits to deny claims for E&M and minor procedures on the same day.

Below outlines the language from the CCI edits. Please let your providers know that if they are billing for a minor procedures and E&M on the same day, there must be enough documentation to support that enough medical decision making is supported other than the simple decision to perform the procedure. The decision to do the minor procedure same day is no longer enough to support both billings. Some examples would be simple lacerations and wart removals.

"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service.

However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.

The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure."

No comments:

Post a Comment