How to Bill an E/M With a Minor Procedure

To determine the appropriate use of modifier 25, review this case study in otolaryngology.

The Cigna Group has delayed the requirement for submitting documentation with claims that involve a 25 modified offices or other outpatient evaluation and management (E/M) service (CPT® 99212–99215) and a minor procedure. Despite the payer not enforcing this requirement, physician practices that submit such claims must ensure their documentation meets clinical review standards. This is particularly important for otolaryngologists who bill for an E/M with an unplanned diagnostic endoscopy.

Here’s the Situation

Minor procedures conducted in an outpatient setting are typically either therapeutic or diagnostic. Diagnostic procedures are usually scheduled and may involve a gastrointestinal specialist performing a colonoscopy, a neurologist conducting a nerve conduction study, or a cardiologist conducting a cardiac stress test. However, in the field of otolaryngology, physicians often perform unplanned diagnostic endoscopies during E/M encounters.

These endoscopies are diagnostic procedures with zero global days and are typically performed as unplanned procedures. Examples include diagnostic nasal endoscopy for nasal and sinus complaints (31231), nasopharyngoscopy for eustachian and nasopharynx complaints (92511), and laryngoscopy (31575) for throat complaints.

https://www.allzonems.com/billing-for-e-m-services-and-minor-procedures/