# MOD 25 usage by dermatologist



## EvanGioconda4624 (Jan 22, 2019)

established patient, derm performs full body or sometimes upper body exam, does cryo and documents that patients old (not from a recent visit) melanoma scar is/has healed nicely.  Scar is usually locate in same area of body as cryo.

Bill procedure and E/M with 25 modifier. 

I say no E/M.

What do you say.

Evan Sade, CHC, CPC


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## cgifford (Jan 23, 2019)

You state a full or partial body skin exam was done, was this documented?  If it was not documented then it wasn't done. But if the full body was done and documented then I would bill the E&M with the Cryo but again the body skin exam would have to be documented in order to consider that.

Colleen, CPC,CPCD,CPB


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## CatchTheWind (Jan 30, 2019)

I agree.  A full skin exam is a billable service as long as there is a "history of skin cancer" diagnosis (not just preventive visit).


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## az2tn@yahoo.com (Apr 30, 2019)

*E/M global or bundled?*



CatchTheWind said:


> I agree.  A full skin exam is a billable service as long as there is a "history of skin cancer" diagnosis (not just preventive visit).




  I'm doing a derm audit. My first one and I'm confused. And I don't code for derm either. So this is all new to me. The edits I'm getting are saying an E/M on the same day as UVB therapy, cryotherapy, biopsy is either bundled or they are in a global and some of these patients are coming in for a skin check with a hx of basal cell, squamous cell and melanoma and then something is found and it is addressed at the visit with a procedure. Could someone point me in the right direction for some official guidance on an E/M being supported if a full skin exam is done?  And are we talking a comprehensive skin exam 97 guidelines? Thank you


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## meghanhannus (Apr 30, 2019)

*E/M global or bundled?*

Hello az2tn@yahoo.com,

I just recently did a few derm audits as well; if the patient presented and was scheduled for the minor office procedure(s) than a separate e/m should not be billed unless it is for a different problem/DX. If the patient presented for their TBSE _(Total Body Skin Exam_) and say seborrhic keratoses was found and cryotherapy was performed than you would bill the e/m service with modifier 25. If the e/m or minor procedure performed within a global period than you would need to make sure the appropriate modifiers were on the service(s). 

As far as the e/m auditing I did follow the 1997 Dermatology Specialty Exam Guidelines. In order to support a billable e/m service the provider would need to do more than only perform a full skin exam. If the patient was established _(where I audit)_ the medical decision making is always one of the two key components used to level out the service. If a new patient the documentation would have to support all three key components _(history, exam, medical decision making)_ to level the service.



I hope this has somewhat helped clarify


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## JesseL (May 17, 2019)

Per some sources, https://www.aap.org/en-us/professio.../Modifier-25-Primer-Use-It-Dont-Abuse-It.aspx

and https://www.medicaleconomics.com/category-47287/everything-doctors-need-know-about-modifier-25

To bill modifier 25:
The E/M service must be significant. The problem must warrant physician work that is medically necessary. This can be defined as a problem that requires treatment with a prescription or a problem that would require the patient or family to return for another visit to address it. A minor problem or concern would not warrant the billing of an E/M-25 service.

So it seems if the separate problem is too minor, modifier 25 is not billable.

I do disagree with this though...


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