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    How to charge for E&M services, procedure on same date

    Modifier –25 usable if E&M service is separate, significant, and identifiable

    Ray Painter, MDRay Painter, MD Mark PainterMark Painter


    Our office has adopted a policy that does not allow coding for an evaluation/management visit on the same date as a previously scheduled cystoscopy. At your course, you said that if an E&M service is separate and identifiable, you can charge for the E&M with modifier –25. If I talk to a patient and/or treat BPH and ED on the same date as a scheduled surveillance cystoscopy, can I charge an E&M with a modifier –25?

    E&M services reported on the same date as a procedure with a global require that the E&M service is separate, significant, and identifiable. There is nothing in the requirement for there to be a new problem, nor is there a rule that states you cannot charge an E&M code on the same date as a previously scheduled service. A cystoscopy has a 0 day global, which includes the related preoperative care, the procedure itself, and the postoperative care, including telling the patient the findings of the services. The postoperative care does not include discussing or treating the disease process related to the procedure or any other disease process. All services regardless of whether they are new or established that are addressed on the same date can be charged if the E&M service is not a part of the procedure(s) provided and it is documented appropriately and accompanied by the –25 modifier.

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    BPH and ED are not related to bladder cancer in your example above. If your E&M note demonstrates the service provided was significant and is identified by appropriate documentation, you are clearly justified in using the modifier –25 on the E&M service and charging both the cystoscopy and E&M.

    Remember that you are not required to have a separate diagnosis for the modifier –25 as long as you meet the definition. For this, consider the patient that is in for a surveillance cystoscopy during which you discover a new growth. The appropriate diagnosis for the cystoscopy is now either “Cancer of the Bladder” or “Unspecified Neoplasm of the Bladder” because that is what you know at the end of the encounter. If you then sit down and talk to the patient about the next steps in treatment of the new growth, the time spent in that discussion is also billable under modifier –25, as the E&M service is separate, significant, and identifiable. That diagnosis would be the same for both.

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    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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