decisionhealth Newsletters, Part B News - 2012 Issue 1 (January)
Ask a Part B News expert: Billing office visits and procedures
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Article Overview
This article addresses a billing and coding question about reporting office visits or other evaluation and management services on the same date as a procedure. It summarizes guidance from the NCCI Manual and Medicare carrier edit concepts, with attention to global periods, procedure types, and when separate reporting may or may not be appropriate. The discussion is aimed at coders, billers, and clinicians who need a high-level understanding of same-day E/M and procedure reporting.
Why This Topic Matters
Correctly distinguishing included preprocedure work from separately reportable evaluation and management services affects claim accuracy, compliance, and denial risk. The topic is especially important for practices that routinely perform procedures and need to understand how Medicare-related billing edits apply.
What You Will Learn
- How same-day evaluation and management services are discussed in relation to procedures
- How global period concepts are framed in the context of major and minor procedures
- How Medicare-oriented claims edit concepts are referenced in the article
- What kinds of same-day service scenarios are considered in the guidance
- How a clinical example is used to illustrate the general billing question
Who Should Read This
- Medical coders
- Billers
- Physician practices
- Compliance staff
- Healthcare administrators
- Clinicians involved in billing documentation
Modifiers Discussed
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