Wiki EM Code with Excision

[rbbrigman]

I am new to dermatology -- I want to know if it is allowed to submit an office visit with an excision, intermediate repair and pathology ---

99212
11402
12032
88305-TC

PA excised a lesion on the trunk 1.8 cm, did a repair for 2.8 cm and sent the excision to the lab

Thank you. For some reason they don't think they can charge for an office visit and do these procedures, I thought it was common. Is there documentation on CMS or somewhere that can give them some guarantee?
Thank you .
Robin

 

[mitchellde]

It depends on the documentation but yes you can bill the office visit with the 25 modifier. If this was a planned procedure however then no you cannot. So the answer is it is allowable it just depends on the circumstance and the documentation. You do not get to charge the path code though even with the TC modifier.

 

[jnwhite80]

Modifier -25 can be appended to the E/M code if the procedure was not one that was scheduled in advance.

If the patient is undergoing the procedure as part of a treatment plan that was established at an earlier date then the E/M visit cannot be used as it is part of the surgical package per both CPT and CMS guidelines.


"So the answer is it is allowable it just depends on the circumstance and the documentation. "

Janice N White, RHIA, CPC, CTR