tci Medicare Compliance & Reimbursement - 2016 Issue 7

Reader Question: Use 25 with New Prolonged Services Codes to Max Out Payment

Question: A 25-year-old new patient reports to the gastroenterologist complaining of consistent pain in the upper left quadrant of his torso; he rates the pain as 9 on a scale of 10. The provider performs an E/M service that includes a detailed history and examination, along with moderate medical decision making (MDM), and decides that the patient needs a screening colonoscopy. While the nurse practitioner (NP) is prepping the patient for the procedure, he begins to question if he really needs the screening. The NP halts the preparations to speak with the patient. She explains to him that his...

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