# E/M, Pap smear, skin tag and comedo removal all in one visit?



## Sanders2011 (Apr 22, 2013)

Hello I have a question regarding billing out an annual pap smear along with skin tag removal and acne suregery (comedo) and a regular office visit all in the same day. The patient was recently seen in our office for her annual pap which I billed out the preventative for her age, then she was also seen for skin tags that were removed and comedo that was removed and also seen for hypertension this is how I coded it 99396-24 for pap, 81002 for the urine, 99213-25 for hypertension, 17110 for skin tag removal, and 10040-59 for comedo removal. Insurance denied the pap 99396 stating it was a global charge the skin tag removal 17110 as services are not appropriate to the dx which is 70219, they paid the 99213, and the 10040 they applied it to the patient's deductible, and the paid the 81002. To me this was way to much to be going on in one visit that was only scheduled for an annual pap smear. Can someone help me with this and tell me what I did incorrectly, and the correct way I should that done it?


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## CELINA0502 (Apr 29, 2013)

If I were billing this in my office I would have used 99214/25 with pap and hypertension as the diagnosis (as long as it was not a Medicare patient).  Then 11200 (701.9)for skin tag removal and 10040/51 for comedo removal.  Hope this helps.


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## rthames052006 (Apr 29, 2013)

Sanders2011 said:


> Hello I have a question regarding billing out an annual pap smear along with skin tag removal and acne suregery (comedo) and a regular office visit all in the same day. The patient was recently seen in our office for her annual pap which I billed out the preventative for her age, then she was also seen for skin tags that were removed and comedo that was removed and also seen for hypertension this is how I coded it 99396-24 for pap, 81002 for the urine, 99213-25 for hypertension, 17110 for skin tag removal, and 10040-59 for comedo removal. Insurance denied the pap 99396 stating it was a global charge the skin tag removal 17110 as services are not appropriate to the dx which is 70219, they paid the 99213, and the 10040 they applied it to the patient's deductible, and the paid the 81002. To me this was way to much to be going on in one visit that was only scheduled for an annual pap smear. Can someone help me with this and tell me what I did incorrectly, and the correct way I should that done it?



What insurance company are we dealing with here?  You're right, that was alot going on in one visit.  Skin tag removal cpt code is 11200-01, the code you listed 17110 is for destruction.

You might need to submit the medical records for all services performed on this date and allow the carrier to review.

I also don't think modifier 24 is warranted on the preventive visit either.


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## Sanders2011 (Apr 30, 2013)

The insurances involved Primary is Key benefits, and secondary is Anthem BCBS.  Sorry the cpt code was correct 17110 but he dx code was 70219 seborrheic keratosis.


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## mitchellde (Apr 30, 2013)

why is there an office visit for hypertension?  did the patient have complaints or symptoms/issues for the HTN?  If the HTN is a chronic issue that was addressed as a part of the preventive then you cannot charge an office visit for this.  I think it probably should have been the preventive with the procedures and that is all.


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