New Pt Office Visit&Punch Bx

Hopp

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Hi there everyone - Just wanted to know if someone would be able to help me coding following: New Pt comes to office with a Susp.lesion and my doc happens to do
punch bx at that time: Documentation: Lesion back suspicious OP: Punch bx
Would I code a new pt visit(25 modifier) along with the Op or do I just code Punch Bx as I thought there was something stating I should only code Op. Thanks for all your help
Deb, CPC (Hoping someone out there can help me as I have gotten different answers re:this)
 

Lujanwj

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Yes, you can bill both the procedure and an E/M with -25, if you can justify the modifier.

NCCI Policy Manual:

D. Evaluation and Management (E&M) Services

If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.

The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.

Example: If a physician determines that a new patient with head trauma requires sutures, confirms the allergy and immunization status, obtains informed consent, and performs the repair, an E&M service is not separately reportable. However, if the physician also performs a medically reasonable and necessary full neurological examination, an E&M service may be separately reportable.
 
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