# E&M same day MOHS



## Texascoder64 (Oct 14, 2012)

I am billing for an office based  MOHS surgeon that ALWAYS wants to bill an office visit same day of the MOHS. The MOHS is planned and that is why the pt is there, but in some cases the Dr. is wanting to charge the e/m because an unrelated site is examined OR because she has never met the patient if referred by partner who did initial biopsy..  Of course, the e/m always denies even with the modifier with Medicare. What if the MOHS codes include a major code with a 90 day p/o like a graft of flap - but the e/m was done due to exam for an unrelated site like an actinic keratosis - the 57 decision for surgery modifier does not seem appropriate because the e/m was not for "decision for surg" for the actinic keratosis, BUT if a major surg is billed then Trailblazer (Medicare) will deny for the modifier since major surg codes were billed.  This has really got me stumped - either way I will have to appeal and provide supporting documentation for prove the e/m was justified -but with MOHS codes 17311-17315 not having a p/o global and grafts/flaps being major surg. - what is the best e/m modifier to use for the unrelated e/m -25 or 57?


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## mitchellde (Oct 14, 2012)

The surgery is planned ahead of time, the physician that did the initial evaluation should have also looked at the additional areas to be thouough.  The E&m on the day of the Mohs is not a billable service since the examination of the area planned to be excised is inclusive to the procedure and you have not a convincing argument that you have an unrelated E&M.  If you feel that you do, your modifier would be a 24.


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## Texascoder64 (Oct 14, 2012)

I thought the post op global does not start until 24 hrs after the day of surgery, so I am not understanding the 24 mod. on the e/m if the post op global has not started yet.  I may be wrong - can you explain? 

Also - I am trying to prove to drs that too many of these e/m's are a "red flag" to payers setting themselves up for an audit ---- I need to convince them.


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## mitchellde (Oct 14, 2012)

you are correct but it is the only modifier for an unrelated E&M, the rationale being that if the patient is there for a planned procedure then there is no other significant or unrelated service that can be performed.  If there is another anomaly that significantly detracts your provider's attention from the task at hand then the procedure should be deferred as there is something more major to be addressed.  There just really is no justification for the E&M at all.  Just to greet a patient because you have never met them is insufficient rationale.  to try to bill for an eval on the same day as a planned procedure is viewed as double dipping.


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## Texascoder64 (Oct 14, 2012)

Thank you Debra - I see that very clearly, great advice! Now I just have to convince these Drs.


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