Primary Care Coding Alert

Are you having trouble deciding when to charge 99201-99215 with 17000-17111? Coding experts answer your toughest questions regarding reporting a same-day service and lesion destruction.
 
Each insurer has its own guidelines for office visits (99201-99215, Office or other outpatient visit ...) and wart removal (17000-17111, Destruction, benign or premalignant lesions), says Susan D. Sajdyk, CPC, a dermatology-family physician billing specialist at Memorial Physicians Inc. in Marysville, Ohio. So, knowing whether to appeal an E/M denial is difficult unless you know that the service deserves payment. When Should You Charge an E/M? You should report the office visit (99201-99215) in addition to the procedure when the family physician performs a significant, separately identifiable E/M services from the wart removal. If a patient comes in for an initial wart removal visit, you should charge an E/M service, Sajdyk says: "The physician has to examine the area, discuss treatment options and perform the removal."
 
When the patient comes in for a retreatment, and the FP doesn't do anything other than the retreatment, you should not typically report an office visit, Sajdyk adds.
 
To show the payer that the E/M is a significant, separately identifiable service, encourage your FP to write different paragraphs for the office visit and wart removal, Sajdyk says. Documentation tip: Document the history, physical examination, assessment and plan in one paragraph. The second paragraph should describe the wart's location, appearance, and removal method. In addition, the notes should include a diagram of the affected body parts.
 
If this is the first time billing the particular insurer, send in the chart notes with the diagram. "That way, you'll know right off the bat whether the payer is going to deny the claim," Sajdyk says. Supplying the additional up-front documentation pays off in easier reimbursement.
 
Keep a chart of insurers that routinely deny the same-day E/M. When a patient with a carrier that bundles the E/M into the office visit, such as Oxford, comes in for wart removal, you can inform him that the insurer will probably deny the service. In this case, you should bill the patient for the charge if your contract allows you to. Do You Need Modifier -25 on the Office Visit?  Although many insurers including Medicare require modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on claims for same-day E/Ms and procedures, not all payers mandate using the modifier. If the FP does something not related to a wart, such as evaluating dermatitis (692.9, Contact dermatitis and other eczema; unspecified cause), you should use modifier -25 [...]