Health Information Management

Wound treated with HBO part of procedure

APCs Insider, March 3, 2004

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

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.

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

      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