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You are here: Home / Articles / Coding Corner Answer: To Bill or Not to Bill an Eval & Management Visit?

Coding Corner Answer: To Bill or Not to Bill an Eval & Management Visit?

August 17, 2018 • By From the College

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Scenario 1 is the correct answer. Although documentation of both scenarios supports a Level 4 visit, only one supports the medical necessity to code an evaluation and management (E/M) visit on the same day with a procedure. Scenario 1 supports the need for a separate E/M visit, because a new problem was assessed and a treatment plan was established during the visit. The diagnosis of pain for the left knee is used because the rheumatologist has not made a definitive diagnosis of osteoarthritis and is waiting to confirm this with the radiology report.

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For Scenario 2, there is no separate and/or significant identifiable reason for the E/M visit, so this does not support the medical necessity of a separate evaluation and management code. The patient was in the office for a second-round injection, and unless there was a separate examination of her RA or a change to her treatment, then an E/M visit for that date of service cannot be justified. Scenario 2 should be coded as CPT: 20611-LT, J7235; ICD-10: M17.5.


For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at [email protected] or call 404-633-3777 x820.

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Filed Under: Billing/Coding, From the College, Practice Management Tagged With: Billing & CodingIssue: August 2018

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