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Dermatology Coding Alert

Separate Your Documentation To Ease Modifier -25 Claims

Published on Fri Oct 08, 2004

To append or not to append? Keep this checklist nearby to lead you to the answer

To ease payment for your modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) patch test claims, here's a checklist to use next time you file your claim:

Have complete and separate documentation for the E/M service, apart from documentation for any other services/procedures the dermatologist provides that day. Treat E/M codes as part of a different encounter. Documentation should independently support every code you claim.

Be sure that the E/M service you report is significant (in a best-case scenario, documentation should support at least a level-three [99203, 99213] patient encounter).

Whenever possible, attach a different diagnosis for the E/M service. Although this is not required, a unique diagnosis will help establish the separately identifiable nature of the E/M service.

Be certain that you are not billing for care included in the global period of a previous procedure. You may not separately report E/M services the dermatologist provides during the global period of a related procedure.

  • For instance, the dermatologist excises a benign lesion (11402, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 1.1 to 2.0 cm). Five days later, the patient returns to the office complaining of redness and pain at the excision site. The dermatologist diagnoses an infection and instructs the patient to apply an antibiotic ointment. You should not bill for that second visit because it's related to the original service and the patient returned within the 10-day global period.

  • If the patient returns within the global days for a different problem, unrelated to the excision, you should report an E/M (99211-99215) with modifier -24 (Unrelated E/M service by the same physician during a postoperative period). 

    Note: If, however, the dermatologist provides an E/M service during the global period of an unrelated surgical procedure, you may report the appropriate E/M service code with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) attached.

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