Wiki Billing a new pt visit and excision

[jcrawforth]

The patient's only reason for the visit was for her mass. I am hesitant to bill the E/M with a 59 as there was nothing else addressed.

The doctor coded a 99202 and a 27327 both with the same diagnosis of D17.9

I am new to surgical/procedural billing and coding

Do I only bill the excision? Thank you in advance!

 

[Chelle-Lynn]

A couple of things....there are a couple of different modifiers that could apply....25, 57, or 59.

When billing an E&M with a procedure, to show a clear and separate service the correct modifier on the E&M would be a 25, 57, or 59. In regards to whether or not the use of this modifier is appropriate would come down to the documentation on the account. The diagnosis alone does not define if the use of the 99202 in addition to the procedure.

In this case you would need to review the medical records to determine if you could justify the occurrence of the E&M portion of the exam in addition to the excision. Remember there is always a certain element of E&M in every procedure, but you are looking for a significant and separate E&M on the same day as the procedure....meaning a service above and beyond what would typically be required for the excision performed.

The options are::::

The E/M service may be prompted by the same symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting the E/M services on the same date. This circumstance may be reported by adding modifier -25 to the appropriate level of E/M service.
This modifier is not used to report an E/M service that resulted in a decision to perform surgery; instead see modifier -57. For a significant, separately identifiable non-E/M service, see modifier -59.
When appending modifier -25 to a significant, separately identifiable E/M service on the same day as a procedure, the evaluation and management (E/M) service must document well the key elements of history, examination, and medical decision-making.