We are having issues with knowing when to add a 25 modifier or not. A pt comes in asking about a lesion on the leg and ends up having a full skin exam, we do a biopsy and we perform cryotherapy on a different lesion found during the exam. We attach 238.2 to the biopsy 11100 and 702.0 to the cryo 17000. The charge comes through with the e/m 99203 or 99213 with diagnosis of 238.2 and 702.0. Should we add a modifier 25 or because both of both diagnosis codes were treated and billed for are the charges for an e/m included in the biopsy and cryo codes? Would we need another diagnosis attached to the e/m that did not have something performed on it?
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Wiki e/m codes
- Thread starter zztoolzz
- Start date
Peter Davidyock
Expert
Has the physician documented that a thorough exam of all sufaces of the body was performed?
Cyndi113
True Blue
Was the patient specifically scheduled for first time skin problem or is the an established problem? If for first time exam, then yes add the -25 and bill E/M + procedures. However, if established problem, I would bill only the procedure with no E/M.
With one established problem exception, has it been treated before and now patient returns with worsening symptoms of lesion. Then E/M + -25 + procedures.
Yup, nothing is black and white in our world!!
With one established problem exception, has it been treated before and now patient returns with worsening symptoms of lesion. Then E/M + -25 + procedures.
Yup, nothing is black and white in our world!!
Our office is also having this outcome. We are under the understanding based on the articles is AAD that procedures with 00 and 10 day globals includes e/m unless something above and beyond that procedure is done. New or established is same. Would appreciate any advise in billing e/m with full body exam. Thanks in advance!