Texascoder64
Guru
I am billing for an office based MOHS surgeon that ALWAYS wants to bill an office visit same day of the MOHS. The MOHS is planned and that is why the pt is there, but in some cases the Dr. is wanting to charge the e/m because an unrelated site is examined OR because she has never met the patient if referred by partner who did initial biopsy.. Of course, the e/m always denies even with the modifier with Medicare. What if the MOHS codes include a major code with a 90 day p/o like a graft of flap - but the e/m was done due to exam for an unrelated site like an actinic keratosis - the 57 decision for surgery modifier does not seem appropriate because the e/m was not for "decision for surg" for the actinic keratosis, BUT if a major surg is billed then Trailblazer (Medicare) will deny for the modifier since major surg codes were billed. This has really got me stumped - either way I will have to appeal and provide supporting documentation for prove the e/m was justified -but with MOHS codes 17311-17315 not having a p/o global and grafts/flaps being major surg. - what is the best e/m modifier to use for the unrelated e/m -25 or 57?
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