I am not sure what you are referencing. If the patient comes in for a scheduled procedure and then has unrelated complaints you may bill an office visit with a 25 modifier for the unrelated complaint. If the patient come in for an office encounter as stated above and also complains of something else while there it is just a second problem and may possibly increase the visit level, but there is no additional charge. So for the original issue you will have rash and breast lump as your dx and the level of service met by the guideline set you are using. So for instance the 95 guidelines say for a problem focused exam you need a limited exam of the affected area plus an exam of a related or SYMPTOMATIC area. Or ofr detailed you need a more extensive exam of the affected area plus a related or symptomatic area. So this will be either expanded focused exam or detailed depending on the documentation if using 1995. 1997 you will follow the bullets for the multi-system set and see how many bullets have been met. You may not charge 2 office visits on the same day. and there is no addtional way to charge for additional exam due to more complaints.From what I was told was that, if a patient comes into the office for issues that are unrelated, it should be billed as unrelated issues. It is payable if you append a modifier with it.