Ask Dr. Z

Can you tell me if there is a way to bill for extra work that may come up during procedures? The example I have now is the patient was in for a declot of dialysis shunt. "The patient was noted to be in atrial fibrillation with left bundle branch block. He was also mildly tachy with rate in 110's. Cardiology was consulted and we decided to give 10 mg of labetalol prior to the procedure. Patient remained asymptomatic throughout denying chest pain, discomfort, lightheadedness." Normally we don't bill an E&M on the same day as the procedure, but would this be a case that an E&M with a -25 modifier would be appropriate? Seems like extra care/work involved prior to the procedure.