Procedure At The Time Of An Office or Post Operative Visit

Coding Question:

Can my doctor bill a Mirena insertion fee when billing for an office visit or post operative visit or should they have the patient come back?
I want to be sure he gets paid.

Answer:

Yes you can bill a Mirena Insertion with an office visit, post operative visit or a postpartum visit if you meet certain requirements and use your modifiers correctly.

Postpartum Visit

The Mirena insertion can be billed during the post operative period (postpartum visit). The Mirena Insertion would be filled with the modifier 79 indicating this was an unrelated procedure or service during the postoperative period.

Modifier 79

Unrelated Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79.

Office Visit

If the patients E/M service is a separate identifiable visit not related to the Mirena insertion both can be billed. You will need to attach modifier 25 to the E/M service which will indicate that this is a separately identifiable E/M service by the physician on the same day of a procedure or service. If the patient is scheduled for a Mirena insertion and no separate identifible office visit is documented you CAN NOT bill for an E/M visit in addition to the insertion.

Modifier 25

Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: may be necessary to indicate that on the day a procedure or service identified by CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.

A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instruction on determining level of E/M service).