tci E/M Coding Alert - 2022 Issue Q1

Reader Questions: Focus on Intended Procedure Rather Than Payer for Cancellation

Question: I have a cosmetic case that canceled after the pre-op exam but before induction. Do I bill an evaluation and management (E/M) code or the time? The anesthesiologist says that no E/M code is needed because it is self-pay. I’m thinking that I should bill the E/M code because the surgery never started due to patient’s atrial fibrillation with uncontrolled rate. Are rules different for self-pay cases? Nevada Subscriber Answer: Discontinuation of anesthesia before drug administration would be an E/M regardless of patient status (insured versus non-insured). You cannot waive charges in a self-pay patient if...

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