Why might a family physician experience denials for the E/M service when billed with a minor procedure?

When a family physician bills for an evaluation and management (E/M) service alongside a minor procedure, denials may occur due to bundling rules established by payers. Payers often have specific policies that package or bundle certain services together, which means that when an E/M service is performed on the same day as a minor procedure, the payer only pays for one of the services.

These bundled services may stem from the understanding that the E/M component is a fundamental part of the minor procedure and, therefore, should not be reimbursed separately. This can lead to confusion regarding payment when both services are submitted, as the payer may classify them as part of a single encounter, resulting in the denial of the E/M service.

Understanding these bundling rules is crucial for physicians and their billing departments, as it informs them about how to properly bill for services and minimizes potential denials by ensuring that documentation supports the billed services according to the payer's policies.