# Office visit and procedure please help



## LACEY13 (May 4, 2010)

I work in a dermatology clinic,  if a new patient comes in for a mole and they do a biopsy and they talk about nothing else can you charge the office visit and the biopsy? 

If an established patient comes in for a new problem of acne cyst and they inject them but talk about nothing else can you bill an office visit and injections?  or if you want to charge an office visit and injection do they have to come back another day?


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## deborahcook4040 (May 4, 2010)

If they come in for a biopsy of a mole, then you can't charge an additional office visit. If your physician has never evaluated this mole, then I would bill the office visit with a "neoplasm of uncertain behavior" code (If it needs to be biopsied, then it's uncertain), and then bill the excision with an ICD based on the pathology report.

As far as the acne cyst goes, has this aptient been evaluated for acne cysts in the past? If so, then I would just bill for the injection.


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## mitchellde (May 4, 2010)

deborahcook4040 said:


> If they come in for a biopsy of a mole, then you can't charge an additional office visit. If your physician has never evaluated this mole, then I would bill the office visit with a "neoplasm of uncertain behavior" code (If it needs to be biopsied, then it's uncertain), and then bill the excision with an ICD based on the pathology report.
> 
> As far as the acne cyst goes, has this aptient been evaluated for acne cysts in the past? If so, then I would just bill for the injection.



I disagree, the 238.x neoplasm of uncertain behavior are dx that can be rendered by the pathologist not the coder.  These are not codes to indicate that the coder is uncertain given the documentation but that the pathologist observes cellular activity that is of uncertain behavior morphologically.  If nothing else fits for the mole then use 709.8.  As far as can you bill an office visit then I would have to read the note.  If the documentation is over above and beyond the procedure then yes you may bill the visit and the procedure.


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## Belinda Frisch (May 5, 2010)

*Yes, to the office visit IF...*

For the first question, NP w/ E/M and biopsy, I'd say yes, bill the office visit ONLY IF there is significant E/M documentation. If the office note reads like a procedure note, then I probably wouldn't. Separating the E/M part from the procedure part of the note is the best way to support asking for payment for both.

Modifiers 25 and 57 are your options for E/M modifying and for minor office procedures, most likely 25, but this is payer-dependent.

Here's an article that illustrates the point:

http://www.supercoder.com/articles/articles-alerts/gac/dont-let-modifier-25-headaches-take-over/

For the biopsy and E/M, use your best judgment as to whether or not there is enough documentation, but don't discount the idea altogether. 

On the second issue of injection and E/M for acne, I'd consider reimbursement. Injections are typically low paying and an E/M would probably be financially advantageous over the injection if you're not able to bill both. My guess is most of your payers bundle these? You can always query your payer reps.

Good luck.


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## ewinnacott (May 17, 2010)

I agree about the biopsy problem.. As far as the acne cyst question..since the 96372 or 90471 bundles with the e/m codes(and you have to code the injection since you said it was done per the notes) you might just have to write off the office visit which is sad BUT if you can pull something else out of the office notes and most of the time you can and as long as its valid per the notes you can bill a e/m visit with a mod -25 and the injection codes. Again this depends on the notes.


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## losborn (May 18, 2010)

*IS THE e/m MEDICALLY NECESSARY?*

I agree that this can be a problem - expecially in a dermatology office.  But you need to be careful here:  just because the amount of work that is done can justify the E/M, doesn't mean the E/M was medically necessary, and medical necessity is what should be driving the OV selection.

Lin


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