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Wiki Modifier 25

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A podiatrist sees many patients for minor procedures (nail trimming, nail debridement, corn and callus removal). Many patients also have a diagnosis of dry skin, and the provider documents a corresponding exam and assessment/plan (apply moisturizer). Would this justify an office visit with modifier 25 in addition to the procedure code?

Thank you.
 
The decision as to whether or not a modifier 25 is supported is never an easy one, and really needs to be taken on a case-by-case basis after reviewing the documentation for the specific encounter. For your scenario above, you would need to look at the note and remove any of the E&M that is related to the procedures that are coded, and evaluate what is left. Considering that the nail and corn/callus procedure already include an exam of the feet, it's most likely that you need enough of a separate history and MDM related to the dry skin to support an E&M code. In other words, does the documentation of the patient's presenting complaint and the amount physician work for this issue support a separately identifiable code? Or is the physician simply incidentally noting, in the course of the other work, that the patient's skin is dry? After all, one doesn't need a physician's skill to tell someone that their skin looks dry and they might try putting lotion on it - there should be a significant medical reason for this that is reflected in the notes. So in reviewing the documentation, I would ask myself, does it show that this is reasonable and medically necessary service that warrants asking the patient and/or their plan to pay a separate a charge for this? Ultimately, if audited or challenged, the coder or the physician will be the ones that will need to point to that document and be able to have a valid and persuasive argument for why the modifier is warranted. Hope this might help some.
 
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