# E/Ms with procedures



## pamtienter (Oct 28, 2008)

I have physicians telling me that they have been told in the past that they can bill an E/M with a derm procedure such as wart destruction or lesion excision. (One says it's always a 99213.) I would agree an E/M would be warranted if it's a new patient and understand that the E/M should be "separate". I've used the 25 modifier description. Does anyone have any good references where I can get information to use as an education tool to define "separate"? I've explained about services unrelated or "above and beyond" the procedure but they would understand better if I had concrete proof. (Or maybe they'd believe me...)  Any tips or ideas?


----------



## Herbie Lorona (Oct 30, 2008)

The definition of the 25 modifier should be proof enought. It states "Significant, separately identifiable evaluation and management service *by the same physician on the same day of the procedure *or other service.". Did you show them the definition in Appendix A of the CPT book?


----------



## Claudia Yoakum-Watson (Oct 30, 2008)

bpct6501 said:


> I have physicians telling me that they have been told in the past that they can bill an E/M with a derm procedure such as wart destruction or lesion excision. (One says it's always a 99213.) I would agree an E/M would be warranted if it's a new patient and understand that the E/M should be "separate". I've used the 25 modifier description. Does anyone have any good references where I can get information to use as an education tool to define "separate"? I've explained about services unrelated or "above and beyond" the procedure but they would understand better if I had concrete proof. (Or maybe they'd believe me...)  Any tips or ideas?



I agree the 25 Modifier definition and description is a good place to start.  Also, please note that an E/M can be billed for a new or established patient, as long as a significantly, separately identifiable E/M is documented.


----------



## jaisheela (Nov 2, 2008)

Modifier -25 can be used to the E&M service on both NEW and ESTABLISHED patient.The physician may need to indicate that a procedure or service was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other services provided.

Jaisheela BPT,CPC


----------

