Wiki 11100 and office visit


Irmo, SC
Best answers
I have a front office person here questioning if there should be an office visit code added to an 11100. The guideline states: The use of a biopsy procedure code 11100, 11101 indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedur/services provided at the time. Such biopsies are not considered components of other procedures when performed on different lesions or different sites on the same date, and are to be reported separately.
Does this mean you do not have to report the E/M office code?

E/M bundled

All surgical procedures require SOME evaluation. If all that is done is what would normally be done in prep for the procedure, then no "separately identifiable" E/M service has occurred and you wouldn't code any E/M in addition to the procedure.

IF a separately identifiable E/M was performed, you would code it with the -25 modifier.

Let's say, for example, that a patient is sent to you for consultation regarding a mole. You've never seen this patient before. You take a history, perform an exam, make your assessment and plan. Let's say that your plan is to perform a biopsy and you schedule the patient to return in two days time for that procedure. You would code the appropriate consult code for today's visit (no modifier needed). Two days from now, you'd code the biopsy with no E/M (even though you'd probably still perform some basic exam and history before proceding).

Now let's take that same scenario, but you are able to perform the biopsy right away in the office on the same date as the initial consult. You would code the consult with a -25 modifier, and the biopsy.

Hope this makes sense.

F Tessa Bartels, CPC, CPC-E/M