Wiki 99201 25 & 17000

[MJohnston2012]

99201 25 & 17000 Our billing company states this is unbillable due to CCI edits. This is not telemed it is a face to face visit. Dx actinic keratosis and multiple seb keratosis. Only the AK was treated with liquid nitrogen destruction 17000. At my former place of employment in 2019 we coded in house and do not remember this being an issue. Have the edits changed or is our billing service incorrect? Date of service 6/22/2020.

 

[thomas7331]

Your billing company is mistaken, there is currently no bundling relationship between 99201 and 17000 in CCI. In fact under CCI, no modifier 25 is required here, although I imagine many payers would deny without it.

I'd note though that if the proposed changed to E&M documentation are finalized, 99201 will no longer be a valid code for payers that follow those rules. But I'm not aware of anything currently in effect that would not allow you to bill these.

 

[Bernadette10]

I wonder when the modifier 25 edit requirement changed with an EM code. It always used to be required with a separately identifiable EM. I haven't been able to find any info on this.