Wiki Modifier Or No Modifier

[toiwalker]

Our office received payment for Biospy of skin 11100 and is including the office visit 99213 the dx for these services were Essential Hypertension 401.1 likned to the office vist and Neoplasm of uncertain behavior of skin 238.2 linked to the biopsy. Could a modifier have been added to the office vist or is the office visit included in the surgical procedure???

 

[terif]

Modifier

If the patient came in for a followup on 401.1 and the 238.2 was an incidental finding then you should bill as:

99213-25 with 401.1
11100 with 238.2

 

[mitchellde]

Our office received payment for Biospy of skin 11100 and is including the office visit 99213 the dx for these services were Essential Hypertension 401.1 likned to the office vist and Neoplasm of uncertain behavior of skin 238.2 linked to the biopsy. Could a modifier have been added to the office vist or is the office visit included in the surgical procedure???

FYI The dx of 238.2 can be given AFTER pathology states it is a neoplasm of uncertain behavior. This is not a dx that can be given if the physician indicates he is unsure of what the pathology will be. If you look at the documentation in the patient's medical record does he really state that the patient has a neoplasm of uncertain behavior? This dx is a pathologic dx that indicates the cellular activity observed under a microscope is of uncertain behavior. Without a path report you should use a 709.8 dx code.