Wiki Wart follow-up, no removal, is E/M warranted?

[pedscoder21]

Hi,

One of our physicians saw a patient today for a "wart follow-up". The patient already had treatment for the toe wart twice before. Here is the documentation from today:

"Here for wart recheck. Has tried otc products for about 6 months, Since has had both canthacur and crythotherapy with no improvement. Warts are limited to between 1st and 2nd toe on the left. Not tender or painful.
Appears well
Warts as described above.
Discussed options including derm referral vs just watchful waiting. For now will do no treatment."

The physician billed 99212. I know that if a patient comes in for wart removal, after it was previously diagnosed, that you do not charge an e/m and only charge for the removal. So, my question: is an e/m warranted for this visit when the diagnosis has already been established?

THANK YOU!

 

[mdeanne]

If your physician charged CPT 17110 or 17111 for treatment of warts those codes have a10 day global you would not bill an EM related to warts within that time period. If no global period applies, an EM can be billed as long as it is medically necessary.

Based on your documentation, your patient presented with unresolved problem (wart) as CC. Your physician provided a problem focused hx and exam, with straight forward decision making. That meets the criteria for 99212.

 

[pedscoder21]

That makes sense - thank you!