Primary Care Coding Alert

Question: My family physician sees a new patient for a colposcopy (such as 57452). Do I need a modifier on the E/M exam?

Georgia Subscriber

Answer: When your FP performs a significant, separately identifiable E/M service in addition to a procedure, you should report the appropriate E/M code (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...) appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), as well as the code for the procedure. Therefore, in your example, you should report the appropriate-level new patient visit code (99201-99205) appended with modifier -25, and the colposcopy code (57452, Colposcopy of the cervix including upper/adjacent vagina).