Hello,
I am new to Podiatry Billing and procedures. I cannot seem to find a straight-forward answer anywhere with my issue. I wish someone would help me with proper use of E/M codes 99201/99202, and 99211/99212. I read where you should not bill these E/M codes on the same day as a procedure, unless it is a distinct, separately identifiable procedure by using modifier -25. Well, what in heck does that mean for a new patient? Separately identifiable from what? from the patient's complaint or separately identifiable from a previous visit (if the patient is not new)? Do ALL NEW patients get billed an E/M regardless of whether a procedure was performed or not? (this is the most important question I have)
Scenario1 : NY medicare NEW patient office visit, 70 yr old man presents and just wants his feet evaluated and long toenails cut, no pain, no complaints. I'll do an evaluation and see 10 long thick mycotic nails, he does not have palpable pedal pulses, has absent hair and atrophic skin. I cut his nails in the office at that time, how should I bill? 99202 AND 11721 q8, or just 11721 q8? E/M pays more, am I to assume that if I just evaluated him and did nothing, I would get paid more by coding the E/M alone? I read where I'm not supposed to bill E/M in lieu of a procedure, but is it OK if I prescribe a topical antifungal and tell him to come back another day for his nails to be cut to be able to code the E/M on that day? I doubt a patient would ever come back if I sent him on his way without doing anything to his nails.
Scenario 2: Same patient comes back another day, wants his nails cut again, no pain, no complaints, same as scenario 1 above, subsequent visit. Would I bill 99211 and 11721 q8 or just the 11721 q8? (This situation I can understand that no E/M should be coded, just want to be sure, since I am indeed evaluating him again for the same issue)
Scenario 3: Another new first-time patient (for simplicity, presents with same single complaint of long thick nails), upon evaluation I see no pulses, no hair, atrophic skin, he does have long thick mycotic nails, but he also has an ulcer under his 1st mpj (patient unaware of it). I take care of his nails and debride his ulcer, non infected, clean wound base and teach him how to take care of it and tell him to follow up weekly. how would I bill this, 99202, 11721 and 97597? or just the procedures 11721 and 97597?
You know what I wish? I wish I could find scenarios with a complete showing of what would get billed to medicare. I mean, complete visit notes and complete cms-1500 forms that would go with that visit. I've seen contradicting or incomplete advice online regarding E/M billing. I've been to a couple of coding seminars, but they get broken down into what constitutes an E/M code, and then other podiatry CPTs, I never saw a complete encounter and coding example. I confess I've been chicken to ask in a group of 200 podiatrists for a complete bill example. I'd love to see a complete cms1500 form for a plain old, run-of-the-mill new podiatry patient, and subsequent vists.
Again, above all, my biggest question would be, do ALL new patients get billed an E/M code regardless of whether a procedure was performed or not?
With all sincerity, thanks for your time. I know I'm not alone in my frustrations with this, feel free to post this on your site if you think it would help others.