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When calculating an evaluation and management (E/M) level or auditing an E/M service, every Medicare Administrative Contractor (MAC) has always had the points assigned for a new problem under the Number of Diagnoses or Treatment Options based on a new problem to the examiner. This means that, although a problem may be established for a […]
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Could Left spermatic cord lesion vs hernia vs hydrocele be included? Our physician is seeing a new patient so this is a new problem and they are getting an ultrasound done to determine the diagnosis.
How exactly does the billing work in this situation? We have tried multiple ways but if we bill the e/m out from the sick visit, after the delivery is billed, the claim is reprocessed and gets denied and when appealing, they still dont get covered.
Does anyone have any insight for this type of situation?
Thank you!
thank you
Robin
Using the 1995 Guidelines, to receive credit for a detailed exam, can a provider perform an extended exam for the 1st affected body area and then a limited exam for the next 1-6 symptomatic or related organ system(s)? Or do they need to perform an extended exam for the 1st affected body area and then an extended exam for at least 1 of the next 6 symptomatic or related organ system(s) to receive credit for a detailed exam? Please feel free to include your sources. Thank you!
In the scenario for the modifier 25 to be use, the other problem must be significant and separate from the procedure.
I’ve read that in order for the other problem to be considered "significant" "This can be defined as a problem that requires considerable workup or treatment, or a problem that, if not addressed at today’s visit, would require the patient to return for another visit to address it. A minor problem or concern would not warrant the billing of an E/M service in addition to a procedure."
So based off of this definition. If a patient for example needed cryo surgery on a wart on the hand, but the patient also has concern of a mole on her face, which the doctor used her dermascope to examine and has deemed it benign, does that separate exam not qualify the use of modifier 25 as that is obviously a minor problem? Because its separate but not significant?