Ob-Gyn Coding Alert

Question: A patient who has had the Pap smear done by another practice was referred to our office for colposcopy. What are the right codes and modifier to use? Maryland Subscriber Answer: If the patient had symptoms and your physician needed to evaluate her prior to deciding that colposcopy was warranted her case, use 57452 (Colposcopy of the cervix including upper/adjacent vagina) or 57455 (....; with biopsy(s) of the cervix) as well as any one of the E/M new patient codes (99201-99205, Office visit for the evaluation and management of a new patient...). Append modifier 25 (Significant, separately identifiable evaluation and management service on the same day of a procedure or other service) to the E/M code. If the patient presents solely for the procedure, then don't bill the E/M code and the modifier. CPT guidelines make it clear that the E/M service must be separate and significant from the [...]