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Wiki E/M and injection

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Akulo

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Would the note below justify the use of modifer 25 since the physician did more than just an injection? Detailed history and expanded problem focus exam documented. 99202-25 & 11900 or should this be considered a malignant destruction? 17276?

Medical Decision Making: Squamous cell carcinoma of scalp
POC: Recommendation is Malignant destruction of SCC. Confirmed bx x2 by pt's former dermatologist,
Irene Lu to be invasive squamous carcinoma. Explained that the tumor is too large for us to operate.
Patient and patient's family also denies that they want to proceed with surgery especially d/t patient's
advanced age. 5-fluorouracil x 2.0cc injected into tumor. Explained that treatment may only slow down the
growth but may not take it away completely like an excision would do. Advised pt to RTC in 3 weeks.
 
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CMS and a few MAC's have written guidelines that New patient visits are exempt from the Mod-25 rules (Palmetto). Thier rationale is that an E&M is appropriate obtain new history and to determine the course of treatment since they have never been seen by a provider before supports a modifier 25. The procedure you are looking for falls into this code set: 96405 - 96406

96405 Chemotherapy administration; intralesional, up to and including 7 lesions
 
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