Wiki 25 or 57 mod

[Texascoder64]

I am having an e/m coding dilemma that pertains to a MOHS surgeon I code for . This is "in-office" MOHS. He wants to code for an office visit same day of the MOHS surgery. He states he examines something else the day of MOHS so an unrelated dx is appended to the e/m (for example actinic keratosis 702.0 surgery not done ) - so if the patient ends up with a flap or graft which is a major surgery - 90 day p/o global - I feel that the e/m code must have a 57 modifier since the surgery is a major code. Either way - I get denials for 99213 with 57 or 25
some of the cpts for a mohs surgery contain a combination of 10 day (minor) and 90 day (major) codes - I have tried the e/m with 25 since there is a minor code on the claim - but the clincher is the 90 day cpt - that requires 57 and always denies.

Is this an automatic denial and have to appeal with note to prove the unrelated e/m was performed?
My thought is if so - this is so counterproductive to have to do an appeal on such a minor problem that could be addressed when the p/o global is over. My rationale to the Dr is the patient is in for a "planned MOHS surgery" why do you have to find something else the day of the surgery. It's not that I am lazy and do not want to do an appeal, but the Dr is just trying to find "something" to put an unrelated dx on. This is one of those "pull your hair out" problems. Would love to get some input on this from others on how to deal with this.
Thanks!

 

[FTessaBartels]

Red flags

The fact that you write that "He states he examines something else the day of MOHS so an unrelated dx is appended to the e/m (for example actinic keratosis 702.0 surgery not done )" makes me think that the physician is "finding" things to examine in order to get an E/M when none is appropriate.

If the MOHS procedure was previuosly scheduled, then there should be NO separately reported E/M ... UNLESS ... the patient has a new complaint.

A -57 modifier is NOT appropriate because the procedure was previously scheduled, this was NOT the decision for surgery.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[Texascoder64]

Regarding your comment F Tessa, as you stated the 57 modifier would not be appropriate since Mohs was planned and (for example- if the "new complaint/problem" ) was actinic keratosis 702.0 , so the ov was not the "decision for surgery" I do understand that.
But what if the MOHS surgery has a 10 day p/o (complex repair 131xx or a 90 day p/o graft or flap, then wouldn't a 25 mod need to be on the e/m ? to state that there was a separately identifiable e/m service performed same day of surgery?

Thanks so much for your input.

 

[Peter Davidyock]

I was unaware that a 90 global procedure could be charged to pos 11.
Is the something unique to MOHS that would make it an exception?
If it's coded correctly you will have to appeal with the notes to substantiate the E/M.

 

[nyyankees]

I was unaware that a 90 global procedure could be charged to pos 11.
Is the something unique to MOHS that would make it an exception?
If it's coded correctly you will have to appeal with the notes to substantiate the E/M.

you can report fracture care in the office that has 90 day global. Could be as simple as ordering PT for a closed fracture (w/o manipulation). Never touch the fracture. All depends.