• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

E/Ms with procedures

pamtienter

Expert
NAB Member
Messages
349
Location
Mound, MN
Best answers
0
I have physicians telling me that they have been told in the past that they can bill an E/M with a derm procedure such as wart destruction or lesion excision. (One says it's always a 99213.) I would agree an E/M would be warranted if it's a new patient and understand that the E/M should be "separate". I've used the 25 modifier description. Does anyone have any good references where I can get information to use as an education tool to define "separate"? I've explained about services unrelated or "above and beyond" the procedure but they would understand better if I had concrete proof. (Or maybe they'd believe me...) ;) Any tips or ideas?
 

Herbie Lorona

Expert
Messages
409
Location
Yuma
Best answers
0
The definition of the 25 modifier should be proof enought. It states "Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.". Did you show them the definition in Appendix A of the CPT book?
 
Last edited:
Messages
114
Location
Madison Area Chapter in Madison WI
Best answers
0
I have physicians telling me that they have been told in the past that they can bill an E/M with a derm procedure such as wart destruction or lesion excision. (One says it's always a 99213.) I would agree an E/M would be warranted if it's a new patient and understand that the E/M should be "separate". I've used the 25 modifier description. Does anyone have any good references where I can get information to use as an education tool to define "separate"? I've explained about services unrelated or "above and beyond" the procedure but they would understand better if I had concrete proof. (Or maybe they'd believe me...) ;) Any tips or ideas?
I agree the 25 Modifier definition and description is a good place to start. Also, please note that an E/M can be billed for a new or established patient, as long as a significantly, separately identifiable E/M is documented.
 

jaisheela

New
Messages
5
Best answers
0
Modifier -25 can be used to the E&M service on both NEW and ESTABLISHED patient.The physician may need to indicate that a procedure or service was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other services provided.

Jaisheela BPT,CPC
 
Top