Often, a single encounter involves both an evaluation and management (E/M) service to diagnose and recommend a plan of care for a patient’s presenting problem and a related procedural service (eg, incision with removal of foreign body). However, an E/M service is only separately reported when it is significant and separately identifiable from the pre- and post-service work of a minor procedural service. A minor procedural service is one that is assigned a 0- or 10-day global period in the Medicare Resource-Based Relative Value Scale (RBRVS) Physician Fee Schedule. The Medicare RBRVS is used by most private payers and Medicaid plans. Under this payment methodology, procedural services include some pre- and post-service E/M by the performing physician. Payer edits, such as the National Correct Coding Initiative edits utilized by Medicare, Medicaid, and many other payers, also bundle E/M services with certain procedures. In some cases, separate payment for a significant,...

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