Pediatric Coding Alert

Question: Our pediatrician recently removed a number of skin tags from one of our adolescent patients. Exactly a week later, the patient came back for an evaluation and management (E/M) service for otitis media. When we billed for both services, the insurance bundled the payments together. Why did they do that, and what could we have done differently to avoid the loss of revenue?

Connecticut Subscriber

Answer: While you should contact your payer directly to find out their reasoning for bundling two different services together, chances are that you submitted the claim for the E/M services during the 10-day global period that is assigned to 11200 (Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions) and other, similar minor surgeries.

Whenever a patient visits for a separate, unrelated condition during a global period, you should attach modifier 24 (Unrelated Evaluation and Management Service by the SamePhysician or Other Qualified Health Care Professional During a Postoperative Period) to the second visit. This will effectively unbundle the service and indicate to your payer that the second service is not included in the global period for the first.