Dermatology Coding Alert
READER QUESTIONS:
Use Modifier 25 on Your New Patient E/M, as Necessary
Published on Sat Nov 07, 2009
Question:
The other lesions were diagnosed as benign, non-symptomatic lesions. Should I report both the biopsy and E/M and add modifier 25?
Virginia Subscriber
Answer:
You should report 11100 (Biopsy of the skin, single lesion) and 99201 (Office or other outpatient visits for the evaluation and management of new patient), appended with modifier 25 (Significant, separately identifiable evaluation and management service on the same day of a procedure or other service). It was the evaluation of the patient's symptoms or conditions that caused or prompted the medical necessity for the procedure (biopsy) to be provided. Although all procedures have a minimal evaluation included in the code, your dermatologist's E/M service was beyond the routine pre-operative and post-operative biopsy counseling.Helpful:
Medicare usually doesn't require a modifier 25 for a new patient E/M with a procedure. Still, it would be safe to check with other payers for their own policies.-- Technical and coding advice for You Be the Coder and Reader Questions provided by Pamela Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas.
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