OK to Code Debridement With Consult?
Posted on 03. Jun, 2009 by in Coding Challenge, Hot Coding Topics
Question: Can you charge for an inpatient consult and a bedside debridement on the same day?
Answer: You can bill for both services as long as the E/M service goes beyond a simple assessment of the area to be treated.
Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) to the inpatient consultation code (99251-99255, Inpatient consultation for a new or established patient …) you report to inform the payer that the surgeon provided a separate E/M service above and beyond the E/M inherent to the debridement.
Report a code from the 11010-11044 (Debridement …) range, depending on the type of debridement your physician performed.
Diagnosis help: You do not have to have a different diagnosis for the consultation and the debridement. However, the documentation should show the medical necessity for the surgeon to perform the separate services and also show that the E/M service provided went beyond the normal preoperative work that is a part of every procedure.
Warning: Additionally, Medicare specifies that the decision to perform a minor procedure in itself is not sufficient justification to separately bill an E/M service. There must be documentation that the service went beyond the evaluation needed to determine the need for the procedure.
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