The AANEM Professional Practice Committee recently conducted an extensive review of the current Billing for Same Day Evaluation & Management and Electrodiagnostic Testing
position statement, taking into account member feedback from the past year and a half. The committee made several edits to the language in the document, and added a fifth common scenario demonstrating when it may be appropriate to bill for a separate evaluation and management (E/M) when performing EDX testing:
The referring physician requests both an E/M and EDX testing be performed by the EDX physician.
A referring provider recognizes that the patient he is referring to the EDX physician may have several potential diagnoses to explain the symptoms or signs which are prompting the referral for the testing and that both a clinical and EDX evaluation will most likely be needed. The referral requests that both an E/M and a separate EDX evaluation be done at the same visit.
If the EDX physician had confined the evaluation to E/M only, the patient would have needed to return for the EDX testing on another day, incurring preventable travel expenses, and management would have been delayed.
While time for an E/M component is inherent in all codes (including the EDX codes), when an E/M meets the following criteria, it may be reported by adding modifier 25 to the appropriate level of E/M service:
- The E/M is performed on the same day as an EDX procedure;
- The E/M fits the requirement of being truly “significant” and “separately identifiable;” and,
- The E/M cannot be considered to be part of the E/M inherent within the procedure
However, if you do bill for a separate E/M, it is critical that the patient’s medical record documents and supports the expansion of the E/M code beyond that which is included as part the procedure.
AANEM members are encouraged to contact the policy department
with any coding and billing questions or concerns.