Dermatology office visit with procedure

GENOWAL

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Is there any documentation that states the rules for billing an office visit when a procedure is also done? I'm new to derm & am getting conflicting responses from providers when I ask if they want to bill an office visit when a procedure is done. I think you can bill an office visit if the decision was made to do a procedure during an exam but if they are scheduled for the procedure only no office visit can be charged. Any suggestoins on where I can get documentation to help me with this? All answers are greatly appreciated! Thanks!
 

sbicknell

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Yes, you are on the right track. Some guidelines:

1) planned procedure--code only the procedure.

2) OV with decision to do procedure---eval and exam requires only the standard pre-procedure work. Code only the procedure

3) OV with decision to do procedure---eval and exam requires more than standard pre-procedure work. Code OV with mod -25 and the procedure

An example to show the difference between # 2 and #3 is ...........
Patient comes in for eval of lesion on right arm. Physician examines and decides he need to do a full body skin exam due to patient's high degree of suntanning. He can code for OV with mod -25 and the lesion removal

Basically there has to be significant separate work perfomed (other than expected pre-procedure work) to support the coding of an E&M with mod -25
 

ewinnacott

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It all depends on what they are coming in for. For example if they are just coming in to get warts or lesions removed then an E/M cannot be charged along with the wart removal since the main reason for them coming in was specifically for the removal. Now if they were coming in for a cold and the doctor found a lesion and it was medically necessary to remove it then you can charge for the E/M and the lesion removal with a mod -25 on the office visit.

Hope this helps
 

mitchellde

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Columbia, MO
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Yes, you are on the right track. Some guidelines:

1) planned procedure--code only the procedure.

2) OV with decision to do procedure---eval and exam requires only the standard pre-procedure work. Code only the procedure

3) OV with decision to do procedure---eval and exam requires more than standard pre-procedure work. Code OV with mod -25 and the procedure

An example to show the difference between # 2 and #3 is ...........
Patient comes in for eval of lesion on right arm. Physician examines and decides he need to do a full body skin exam due to patient's high degree of suntanning. He can code for OV with mod -25 and the lesion removal

Basically there has to be significant separate work perfomed (other than expected pre-procedure work) to support the coding of an E&M with mod -25

Well done! exactly how I would explain it.
 
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