# Modifier 25 - Patient sees dermatologist for skin



## LWHITED (Feb 25, 2008)

Please let me know your thoughts on the following.

Patient sees dermatologist for skin lesion and the decision is made to remove lesion either by excision or cryo. The physician is doing what he calls a waist up exam looking for other lesions. Documentation reflects only "waist up exam ok” and description of cryo/excision procedure. 

Now for my question. Would it be appropriate for that doctor to bill a 99212-25 for that waist up exam?

Thank you,
Linda CPC


----------



## member7 (Feb 25, 2008)

I'll offer my two cents.  If the dermatologist is examining the patient for similar lesions as he removed in his procedure would that be considered separately identifiable and distinct?  He did perform a "piece" of an exam on a different part of the body, so I would consider giving him credit for it.


----------



## LWHITED (Feb 25, 2008)

Yes as you said he did do a piece of an exam. I have a hard time with the medical necessity of that piece. Would it be considered screening or due to the fact that the patient has this one lesion on  back would that then give him the necessity to exam other skin areas?
Thanks for your reply,
Linda


----------



## robin1019 (Feb 25, 2008)

If The Doctor Did Remove Lesion Use A Modifier 25.. Then He Would Get Paid For The Office Visit And The Lesion Removal..


----------



## member7 (Feb 26, 2008)

I suppose it could depend upon what the patient's history and age is and if the physician felt it necessary to check for potential abnormalities.  You asked a challenging question.  Medical necessity, as you have indicated, is usually a gray area.


----------



## mbort (Feb 26, 2008)

Does the removal of the lesion CPT code carry a 10-day global?  This determines the use of the -25 versus a -57.


----------



## cfuficat (Mar 11, 2008)

*Waist Up Exam*

If the doctor only documents "waist up exam" without listing each area examined, NO I would not code an office visit on a new patient because you will not have the required 3/3.  If established, must have 2/3.

See for new vs established patient for modifier 25.http://www.medicarenhic.com/cal_prov/articles/modifier25_1006.htm


Thanks,

Christy
CPC, RHIT


----------

