Texascoder64
Guru
I am in the process of trying to educate providers (M.D. & P.A)of a dermatology practice on proper documentation on their office visits same day of an office surgery. Most common in office surgeries are: MOHS , general derm (like excisions cpt114xx, 116xx, cryo 17000 or 17110, etc...)
Every visit is being charged with an office visit 99213 -25 mod even though I can see that for example, the pt was in for the first visit and 2 weeks later they are returning for a "planned" surgery like MOHS or a "re-excision" of a dysplastic nevus or BCC. I am trying to tactfully explain that if the reason for the visit for surgery was planned and previously diagnosed on prior visit , then no E/M is justified. Their argument is that - "well, we discussed something new and may list a "wart on the hand" or actinic keratosis on the scalp, etc" I still do not feel that mentioning this one other little "spot" justifies 1. a level 3 e/m, and 2. they are just finding something that is really not the reason the pt is there. They are there for MOHS or re-excision. I get the feeling that the provider is oblivious to this and as long as something unrelated to the surgery is documented , then they will be safe.
I can understand, sometimes new problems come up during the planned surgical appointment, but I feel that ALWAYS putting a 99213-25 is a "red flag" to payers. Does everyone agree on this?
Medicare has sent a letter that stated use of 25 modifiers is excessive. I have explained this is a warning letter. This tells me that this provider is on the radar for RAC audits. Can someone give me a objective opinion and how you suggest I approach this with this group of providers.
Every visit is being charged with an office visit 99213 -25 mod even though I can see that for example, the pt was in for the first visit and 2 weeks later they are returning for a "planned" surgery like MOHS or a "re-excision" of a dysplastic nevus or BCC. I am trying to tactfully explain that if the reason for the visit for surgery was planned and previously diagnosed on prior visit , then no E/M is justified. Their argument is that - "well, we discussed something new and may list a "wart on the hand" or actinic keratosis on the scalp, etc" I still do not feel that mentioning this one other little "spot" justifies 1. a level 3 e/m, and 2. they are just finding something that is really not the reason the pt is there. They are there for MOHS or re-excision. I get the feeling that the provider is oblivious to this and as long as something unrelated to the surgery is documented , then they will be safe.
I can understand, sometimes new problems come up during the planned surgical appointment, but I feel that ALWAYS putting a 99213-25 is a "red flag" to payers. Does everyone agree on this?
Medicare has sent a letter that stated use of 25 modifiers is excessive. I have explained this is a warning letter. This tells me that this provider is on the radar for RAC audits. Can someone give me a objective opinion and how you suggest I approach this with this group of providers.