Health Information Management

Report an E/M level with a debridement code only if the facility provides significant and separately identifiable services from the debridement

APCs Insider, August 8, 2008

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

QUESTION: I code for a wound care facility and I disagree with my colleagues on when to assign an evaluation and management (E/M) level with a debridement code from the 11040-11044 range. It is my understanding that if the visit is for a debridement, then we should report only the debridement code and not an E/M level charge?unless the visit was also for another reason other than debridement. For example, ?check on blood pressure and new medications prescribed? or ?patient running fever and antibiotic prescribed.? When can we report an E/M level with a debridement code?

ANSWER: As we discussed in last week?s APCs Weekly Monitor Q&A, in order to report an E/M visit with a procedure such as a debridement, the visit service must be significant and separately identifiable. To analyze whether this is the case, start with the procedure that the facility provided. Were there any services that were significant and separately identifiable beyond the usual preoperative and postoperative services provided with the debridement procedure?

In both of the examples described above, the facility provided work that was beyond the usual preoperative and postoperative services performed with the debridement. If fappropriate documentation is present for these services, you should bill them separately as an E/M visit and append modifier -25 to indicate they are significant and separately identifiable from the pre-operative portion of the debridement procedure.

 



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Comments

0 comments on “Report an E/M level with a debridement code only if the facility provides significant and separately identifiable services from the debridement

 

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular