99213 with procedure 17110

LKaf7

Networker
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75
Location
Parma, OH
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Hello,

Based on this example, could a 99213 be billed with the procedure 17110? I feel documentation does not support at 99213. Any input is appreciated.

Patient presents with:
Wart
removal in pointer finger right hand
Has warty growth on right index finger and small lesion on middle finger. Lesions have been there for a couple of months.
Also due for HPV #2

Physical Exam:
Constitutional: Appears well-developed and well-nourished
HENT:
Head: Normcephalic
Skin:
Has 1 cm wart on dorsal surface distal phalanx right index finger
2mm wart on distal phalanx of middle finger
Both warts frozen x 3
Pt tolerated well

Thank you!
 

Chelle-Lynn

True Blue
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Location
Modesto, CA
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Based on the documentation you noted, it appears that the patient presented for a specific service which was the removal of the wart. The services rendered were problem focused from start to finish, and seem to allow for the procedure only.
 

thomas7331

True Blue
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I agree, there isn't enough documentation of a separately identifiable E&M to support the modifier 25.
 

LKaf7

Networker
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75
Location
Parma, OH
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Thank you! Any suggestions on how to explain this to the provider? I advised that documentation does not support a LOS and it is a procedure only visit, but they disagree.
 

thomas7331

True Blue
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My suggestion would be to print out Medicare's Global Surgery Fact Sheet (link below) and use that as a reference. The section in the purple box at the top of page directly addresses this. Also look at the section on Pre-operative period billing that starts on page 5, in the second paragraph is states: "When the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine pre-operative service and a visit or consultation is not billed in addition to the procedure." Hope this helps some - it's never an easy concept to have to explain to a provider.

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf
 
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