Dermatology Coding Alert

Question: The dermatologist excised an "uncertain behavior" neoplasm from a patient's skin. Five days later, the patient returned and the dermatologist discovered during a pre-op exam that the neoplasm is now malignant. The physician wants to bill 99214 in addition to a prolonged-service code for that visit. Should we not bill the visit because of the global period, or should I bill the codes with modifier 24?


California Subscriber

Answer: If the dermatologist provided the pre-op exam for an unrelated surgery, you should report 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...) and attach modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code. (For more information, see "Keep Your E/M Modifiers Straight With These Simple Tips" earlier in this issue).

The physician's discovery of the lesion's morphology alone is not significant enough to count that as separate from the pre-op visit. You should report the appropriate prolonged-service code (99354-99360) only if you have documented the extra time the physician spent with the patient.

For instance, if the physician spent an hour and 25 minutes with the patient, you could report 99214 (... Physicians typically spend 25 minutes face-to-face with the patient and/or family) and +99354 (Prolonged physician service in the office or other outpatient setting ...; first hour [list separately in addition to code for office or other outpatient evaluation and management service]).

Answers to You Be the Coder and Reader Questions were reviewed by Linda Martien, CPC, CPC-H, National Healing Corporation of Boca Raton, Fla.; and Jeffrey Weinberg, MD, director of the Clinical Research Center, department of dermatology at St. Luke's-Roosevelt Hospital Center in New York City.