# E&M with skin tags



## jbeckmann (May 3, 2018)

My plastic surgery office would like to bill skin tags as cosmetic only.  We have Medicare sign the ABN form. They would also like to bill the office visit to insurance. The reasoning is that the patient calls in with a lesion of concern- we do not know it is a skin tag- we evaluate it and determine it is a skin tag and tell the pt we will remove it for a cosmetic fee- the patient is ok with this so we remove. They say that they are evaluating this and that should be billable. We are creating 2 encounters  one for the insurance and one for cosmo. As long as this is a new problem that we are evaluating is this billable with an e&m?
Thanks!


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## thomas7331 (May 3, 2018)

Per CMS global surgery policy, "_*The initial evaluation for minor surgical procedures and endoscopies is always included in the global surgery package. *Visits by the same physician on the same day as a minor surgery or endoscopy are included in the global package, unless a significant, separately identifiable service is also performed._"  So in other words, no, the evaluation of the skin tag is not billable if those lesions are removed on the same day, unless there is something separately identifiable documented.  The fee your office accepts for the removal should be set so that the physicians are compensated for the work of the related evaluation.  It is not correct coding to bill a separate office visit charge if there is nothing unrelated to the procedure done at that visit.


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## ellzeycoding (May 3, 2018)

The issue is that some skin tags aren't covered as medically necessary, so you cab't bill the carrier for the skin tags.  They may be covered if irritated, or inflamed, etc.

Even though they aren't covered, you can still only bill the 11200/11201 to the patient as the previous poster stated because the E/M related to the decision to perform is included in the minor procedure of the shave removal.

So you can only bill the patient the 11200/11201 fee as cosmetic.


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