tci E/M Coding Alert - 2022 Issue Q3

Back to Basics: Don’t Rely on a New Condition for an Established Patient to Bill E/M

Hint: Lean heavily on ‘evaluation’ for justification. Last month, we discussed examples of when two distinct problems can and can’t justify the use of modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). We also started discussing the documentation required to report an E/M service when a new patient comes in for a procedure. In part two, we’re picking it up with similar examples and advice pertaining to established patient encounters, as well as some specific...

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