# Simple repairs (12001 and 17000) & E&M....



## dirctn2pnt@outlook.com (May 11, 2009)

If a pt comes in for a hand wound or warts ect, can you bill the appropriate E&M level with the modifier 57, plus the CPT code for the surgical procedure. 

Say a 99213-57
         12001
         90471
         90702 

Insurance is denying the ov as inclusive, cci edits show it is not mutually exclusive....

I know what the cpt surgical package states... looking for clarification. 

Sara and Danielle
coders at our office. 
THANK YOU


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## msjoy216 (May 11, 2009)

*repairs (12001 and 17000) & E&M*

If I'm not mistaken the correct modifier to use would be 25 so it would not deny as inclusive.  ie 99213-25, 12001, 90471, 90702.

Hope this helps 

Crys


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## FTessaBartels (May 12, 2009)

*Significantly separate E/M*

Actually the basic evaluation & management of the problem is INCLUDED in the RVUs for the procedure. So unless you have a *significant separately identifiable *E/M (e.g. also treated HTN or runny nose) I would not code ANY E/M service. 

You wouldn't use the -57 modifier because the procedure is not "major" surgery (90-day global).

F Tessa Bartels, CPC, CEMC


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## dpeterson39 (May 15, 2009)

If the decision for minor surgery was made on the same date then append the -25 modifier to the e/m for minor procedures. The only time the e/m is bundled is if the decision for surgery was made during a previous visit. Check out the AAFP website through Google or your search engine of choice. I would post the link but do not want to go against the AAFP's copyright. Another good place to look is CMS or your local Medicare Carrier's site.


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