Wiki MODIFIER 25 ON E&M for minor problem

[JesseL]

Modifier 25

I read that for the use of modifier 25, the E/M service must be significant. The problem must warrant physician work that is medically necessary. This can be defined as a problem that requires treatment with a prescription or a problem that would require the patient or family to return for another visit to address it. A minor problem or concern would not warrant the billing of an E/M-25 service.

Does this mean that say a patient came to treat a wart via cryo. Patient also complaints of dry skin on arms and legs and the doctor examined these areas and advises patient to use over the counter lotions. Does this not justify 99212-25 and 17110?

https://www.aap.org/en-us/professio...000&nfstatusdescription=ERROR:+No+local+token

 

[smoore123]

Without seeing the note it is difficult to access if the documentation supports a significant AND separately identifiable service to support an E/M with modifier 25.

 

[JesseL]

CC
F/u wart on hands

cc2
dry skin
arms and legs

ROS: admits skin problem (dry)

examined areas arms and legs

dx 1 xerosis on arms and legs
POC: over the counter lotion. dry skin hand out given.

dx 2 viral warts
POC: cryotherapy performed on wart, ln2 applied on warts.

 

[smoore123]

My recommendation would be to use this as an opportunity to review and educate the physician. He/She did an exam however the exam documentation is lacking. What were the pertinent positives and negatives? Without the exam substantiating the use of the modifier 25 for an E/M I would say this does not support an E/M.