Wiki Medicare requesting office notes for AK's

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cgifford

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We have just received a two page remit asking for medical notes for charges that had office visit w/ mod 25 and AK's, ISK's or BX's on the same day. Is anyone else receiving these requests. We use to get one every once in a while asking for notes but this is 10 claims on a remit at one time.
 
Minor surgical procedures INLCUDE the E/M service. The only way the E/M can be billed if it's separately identifiable (basically unrelated to or above and beyond) the other procedures you performed.

They are wanting to make sure you have a separately identifiable E/M service and not just slapping modifier 25 on each and every E/M visit.

The E/M is included for both new and established patients!

Do the highligher test! Basically highlight any E/M you did related to the procedures. CC, HPI, ROS, PFSH, exam, and medical decision making. Look at what remains. Is it enough to stand on its own as a separate E/M. If so, what E/M level could you justify based on what's left?
 
Dermatologist in particular find the need to use modifier 25 more frequently than many other specialties, and with that modifier being constantly under review, it means that you are more likely to face a review of your records. Our practice had large requests like this frequently.

It is frustrating, but modifier 25 is heavily abused (maybe not on purpose, but it is) and the OIG has identified it as a code that leads to inappropriate payments.

Make sure that your practice is using the modifier correctly, and that you are documenting a patient's visit accurately and correctly. While time consuming, the reviews happen for a reason for this modifier and as long as you can support the separate visit, you have nothing to worry about!

Karl, in the post above has a great and super useful tip that I used for dermatology and still do. His highlighter tip absolutely works to ensure an office visit stands on its own. I see he is from Ellzey Coding, and that is where I originally learned the tip.

I know how frustrating it can be.
 
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