Wiki New Patient visit w/ procedure

[d_imparato]

I have a physician who saw a new patient for a lesion removal. This is a Medicare patient. My question is...Does a "New Patient visit" constitute the usage of the 25 modifier since the procedure was done on the same day OR does the physician need to address 2 separate problems?

This is what the codes charged are: 99202 & 17110 w/ the Dx 709.8.

Thank you all, in advance, for your input.

Donna, CPC

 

[thomas7331]

CMS is quite explicit that a new patient visit alone does not justify billing an E&M on the same day as a minor procedure. There has to be documentation to support the modifier 25, that there was significant E&M above and beyond the normal pre- and post-operative work associated with the procedure on that day. It doesn't require a separate problem, just evaluation and management more than that which is associated with the procedure.

There's a section about this in CMS' global surgery fact sheet that you can find here:
https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

 

[d_imparato]

Thank you Thomas. I appreciate your response and the link.
Donna