Wiki Debriment code with E/M level

[tviruet]

The following documentation was billed and denied when we billed:
99212 & 11721
Should I attach modifier 25 to the E/M code?

Thank you.

76 y.o. female NIDDM with CC painful elongated thickened nails. Nails are painful when she Is walking in her Shoes or sneakers.


PE: + elongated thickened painful dystrophic nails X 10 with subungual debris.
- interdigital maceration, - ulcers, - fissures, - SOI
Skin is dry and scaling plantarly
DP/PT 2/4 B/L CR 1 sec X 10 TG WNL B/L - pedal edema


ASS: Onychomycosis X 10, Xerosis


TX: Debridement of mycotic nails X 10.
Rx Lac Hydrin 12 % Lotion 8 oz bid 3 refills


F/u 3 months

 

[ajs]

The following documentation was billed and denied when we billed:
99212 & 11721
Should I attach modifier 25 to the E/M code?

Thank you.

76 y.o. female NIDDM with CC painful elongated thickened nails. Nails are painful when she Is walking in her Shoes or sneakers.


PE: + elongated thickened painful dystrophic nails X 10 with subungual debris.
- interdigital maceration, - ulcers, - fissures, - SOI
Skin is dry and scaling plantarly
DP/PT 2/4 B/L CR 1 sec X 10 TG WNL B/L - pedal edema


ASS: Onychomycosis X 10, Xerosis


TX: Debridement of mycotic nails X 10.
Rx Lac Hydrin 12 % Lotion 8 oz bid 3 refills


F/u 3 months

You would need to use modifier 25 to show that the procedure done after the evaluation of the problem.

 

[RhondaJohnson]

Since the E/M was all focused on the nails and then he determined that they needed debridement, the E/M level is included in the procedure code. You would only be able to code an E/M in addition to the debridement if the E/M was pertaining to a problem other than the nails (e.g. cough, high blood pressure, etc.) I am in compliance so I take the conservative road.

Rhonda