Wiki 99213 with procedure 17110

LKaf7

Networker
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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!
 
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.
 
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.
 
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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