Consultations, E&M and Biopsy


Best answers
My physician has read an article by a Dermatologist stating that we can charge a consultation code, and then charge a new pt E&M code to anyone but Medicare after already seeing them for a consultation. Does anyone else charge a consultation fee? Any luck with payment? The article also stated that we CAN charge a 99212 and Biopsy code together and get paid for both. Medicare, and other insurance has denied this stating the removal is included in the E&M. Any thoughts on this would be great. We are telling her NO, but she thinks she can even when we show her proof. Most insurance companies follow Medicare guidelines. Thank you for taking the time to read and and comments are welcomed


True Blue
Local Chapter Officer
Modesto, CA
Best answers
Billing a Consult and then a New Patient Visit....
If the provider has seen the patient for a face-to-face visit, in this case a consult, then no, it would not be inappropriate to bill the next visit as a New Patient. A new patient can only be billed if it is the first face-to-face visits within 3 years for the patient with that provider. This would be regardless of the carrier as it comes down to coding guidelines and the definition of a new patient.

Billing an E&M with a Biopsy...
In regards to whether or not this is appropriate comes down to the documentation from the provider on the date of service. For the 99212 to be payable it would need to be billed with a modifier 25, which again would indicate that the E&M service was significant and separately identifiable from the procedure.