Code E/M Visit, Procedure Separately for Minor Dermatological Problem
Published on Fri Feb 01, 2002
Often a patient comes in for a regular office visit, and the family physician (FP) discovers a dermatological problem such as a mole, wart or skin tag. Instead of asking the patient to return, the physician usually performs an excision, destruction or biopsy during the office visit. Receiving proper reimbursement for these common encounters involves billing the visit and the procedure separately.
"In most cases, when an E/M visit turns into a dermatology procedure, coders should bill for the office visit and procedure separately," says Barbara Cobuzzi, CPC, CPC-H, CHBME, president of Cash Flow Solutions, a physician reimbursement company in Lakewood, N.J. "And append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code."
For example, a 52-year-old woman presents to have her asthma checked. The FP discovers a skin lesion on her back, and the doctor performs a biopsy immediately. You can bill for the biopsy (11100, biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed [separate procedure]; single lesion) and the appropriate E/M visit in this case 99212 or 99213 (office or other outpatient visit for the evaluation and management of an established patient) with modifier -25 attached to the E/M code.
"The minor surgical procedure does not raise the level of the office visit because it is considered separate," Cobuzzi says.
"A lot of payers don't want to pay for the office visit separately for these types of visits,'' says Carol Sissom, CPC, senior consultant at Health Care Economics Inc., a coding and practice management firm in Indianapolis. "It's helpful to send the documentation for the office visit.''
Know the Starred-Procedures Rules
Many of the dermatology removal codes are starred. Associated pre- and postoperative services are not included in starred codes. The surgery guidelines in CPT 2002 state that when a starred procedure is performed at the time of an initial or established patient visit involving significant identifiable services, "the appropriate visit is listed with the modifier -25 appended in addition to the starred procedure and its follow-up care."
For example, a 48-year-old man presents to have his blood pressure checked. While listening to the patient's lungs, the doctor sees a suspicious mole of 0.3 cm on his back and shaves it off. Code the appropriate E/M visit and append modifier -25. Also code for the mole removal with 11300* (shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs, lesion; diameter 0.5 cm or less).
But when a new patient comes in and a starred procedure is performed, different rules apply. For example, a new patient presents, and at the beginning of the visit the [...]
