Wiki modifier 25~confuse

[ppt]

I have case where patient has a mole on her arm and saw her doctor for the mole. The doctor examined her and removed her mole. Can provider bill E/M code with modifier 25?

Thank you for any advice.

 

[ollielooya]

from what you state, it sounds like a simple procedure without an EM attached. A simple exam is inherent to the procedure which would be captured by the mole removal itself. That's my understanding. Others will hopefully chime in here too. There's enough information on the forum that you can do a "search" function and obtain other answers with pertinent authoritative guidance that will assist you.

 

[Nihema12]

I have case where patient has a mole on her arm and saw her doctor for the mole. The doctor examined her and removed her mole. Can provider bill E/M code with modifier 25?

Thank you for any advice.

Good Day-No

It's a minor procedure and does not meet the rquirements of an E/M. Only bill for the service performed and you will be fine. No -25 Mod needed

Hope this helps
Nihema

 

[Lynda Wetter]

The real trick here would be convincing the Physician who deos the procedure that the evaluation to determine that the minor procedure is to be done does not justify an office visit.
Constant battle.
They feel they should be reimbursed for the time they spend determining whether or not to suture, or remove a wart.
Even after explaining they are reimbursed throught the RVU's on the minor procedure.

 

[LaVoncye]

You cannot bill a 25 as the visit was based around the mole. If the patient came in for another matter like a cold, then the patient mentioned the mole and it was determined it needed to be removed during the same visit then you put the 25 on the e/m code and billed the minor surgical procedure separately on the same claim with two separated ICD 9codes.