ED Coding and Reimbursement Alert

Question: After a level-three ED evaluation and management (E/M) service, the physician shaves a pair of dermal lesions: one 2.1 cm lesion from the left hand and a 1.2 cm lesion from the left arm. Do I need a modifier to report this encounter?

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Answer: You won’t need a modifier — you’ll need four. On the claim, report:

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99283 to show that the E/M and lesion shaving were separate, significantly identifiable services
• 11308 (Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm) for the shaving of the hand lesion
• Modifier LT (Left side) appended to 11308 to indicate laterality
• 11302 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm) for the shaving of the arm lesion
• Modifier LT appended to 11302 to indicate laterality
• Modifier 51 (Multiple procedures) appended to 11302 to show that you are reporting multiple procedures.