Gastroenterology Coding Alert

Question: My gastroenterologist typically provides E/M services and consultations in the office, so additional service rules are a little tricky for me. During a level 3 office consultation with a patient last week, the physician discovered and had to cauterize an anal lesion. Would the cauterization call for a separate code or is that service included in the consultation code?


Indiana Subscriber


Answer: If your documentation includes evidence that supports both services, you can report both codes. Follow these steps to filing the claim:

Step 1: Report one of the following codes, depending on the destruction method:
   46900 (Destruction of lesion[s], anus [e.g. condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; chemical)
   46910 ( ...electrodesiccation)
   46916 ( ...cryosurgery)
   46917 ( ...laser surgery)
   46922 ( ...surgical excision)
 
Step 2: Report 99243 (Office consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity) for the consultation.

Step 3: Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show that the consult and the cauterization were significant, separately identifiable services.

Remember: Attach modifier -25 to E/M codes only; the mod is not designed for use with any procedure or surgical codes.