Health Information Management

Wound treated with HBO part of procedure

APCs Weekly Monitor, March 3, 2004

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QUESTION: Can you code both C1300, hyperbaric oxygen (HBO) under pressure, full-body chamber, per 30-minute interval along with an evaluation and management (E/M) visit (99211) if the visit was for wound dressing to the same area being treated with HBO? I question whether this is separately identifiable.

ANSWER: It is important to understand that C1300 and 99211 reported together on a single outpatient claim will trigger outpatient code edit 21, "medical visit on the same day as a status SI, T, or S procedure" without modifier -25. Modifier -25 is billed with an E/M code to indicate that on the same day a procedure was performed, the patient's condition required a significant, separately identifiable E/M service (even though the E/M service may be necessary because of the symptom or condition for which the procedure was provided).

Use modifier -25 for an E/M service if the patient's condition requires a significant separate E/M service. Look for appropriate documentation of services as listed below:

  • Above and beyond the procedure performed
  • Beyond the usual preoperative and postoperative care associated with the procedure
  • When a separate history was taken, a separate physical was performed, and a separate medical decision was made and is documented in the medical record
  • Performed by a different physician in a hospital setting

    In this example, dressing the wound being treated with HBO is part of the overall procedure and would not be qualify as a separately identifiable E/M service.



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