Pediatric Coding Alert

Question: What is the correct way to bill 99391 and 17250 during the same encounter in the office? Does it require a modifier?

California Subscriber

Answer: You'll need to separate the services on your claim and, yes, you'll need a modifier. Start with the applicable E/M service from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Next, report 99391 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...) with the appropriate diagnosis, such as 771.4 (Omphalitis of the newborn). Lastly, report 17250 (Chemical cauterization of granulation tissue [proud flesh, sinus or fistula]). You'll need separate documentation with the diagnosis and separate procedure notes to round out your claim.