Coding New Patient and Procedure

I ran into a nurse practitioner friend the other day in the local coffee shop. He asked me about a coding dilemma he had encountered recently. He had a new patient come in and present with a cyst on her upper thigh. The cyst was inflamed and needed to be treated. The patient was a young girl with state medicaid as her primary insurance carrier. The patient presented with no other issues. He performed a new patient evaluation and performed an incision and drainage of the cyst. His question was can he bill both codes or bill only one of them. I informed him unfortunately that he can only bill one of the codes. He had documented the entire visit as well as the procedure. He expressed his dismay that he couldn’t bill both codes. If the patient had presented with several different issues he could in fact bill both codes with a modifier 25. Since the patient presented with just one problem, he would have to decide which to bill. The procedure code actually includes the E&M portion of the visit. I, however, informed him that I would bill the E&M code and use diagnosis indicating cyst on upper thigh L72.0. When you as a practitioner, encounter billing dilemmas such as this, consult with your billing personnel to ensure you have documented the visit correctly and more importantly that you have coded the visit correctly. Coding can be challenging but with proper education and experience the challenge can be overcome.