Explore this issueMarch 2009
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Does this situation sound familiar? Your patient comes in on the day of a scheduled procedure and says, “Oh by the way … .” If your encounter, instead of being a scheduled procedure, turns into something more, you can bill Medicare for the E/M visit by adding modifier -25 to the E/M procedure code if appropriate.
This visit should be billed with a mid-level E/M visit—99213-25 (an expanded history and exam was performed on the patient because of his new diagnosis, wrist pain with a medical decision making of low complexity), along with the following procedural and diagnosis codes:
20610 – Major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa)