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Pediatric Coding Alert

Test Your Modifier -25/-59 Knowledge

Published on Sun Sep 28, 2003

This flow chart simplifies your options

You can avoid denials for second procedures, such as 17000 following 12002, if you append the right modifiers.

Read the following scenario and answer the coding-expert-provided questions in the chart below to determine when to use modifiers -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and/or -59 (Distinct procedural service).

Coding scenario: On the way to his pediatrician's office for a scheduled plantar wart removal, a child slips and falls out of the family's sports utility vehicle and cuts his knee. The pediatrician decides that the wound requires closure and performs a simple 3.2-cm laceration repair (12002*, Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm). In addition, she still performs the scheduled cryotherapy for wart removal (17000*, Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion).

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