Wiki Prescription Drugs with a Procedure, E/M or no?

[SBilb89]

Hello all. I work in dermatology and so I see a ton of use of the 25 modifier. I'm still not quite sure what counts as significant and separate when the procedure and E/M have the same diagnosis, and I've heard differing opinions.

Example: A patient has Hidradenitis Suppurativa (a chronic condition, not at goal). They come in and get an injection to three active lesions. The provider also instructs the patient to continue their current meds, and prescribes a new prescription for antibiotics. Would you add an E/M for the prescription medication management?

Example 2: The patient comes in for cryotherapy to painful warts on the fingers. The provider instructs the patient to apply salicylic acid to the warts after the cryo heals. Would you add an E/M here?

I would appreciate any guidance regarding trickier E/M situations like this.

Thanks!

 

[kwatson0]

Hello all. I work in dermatology and so I see a ton of use of the 25 modifier. I'm still not quite sure what counts as significant and separate when the procedure and E/M have the same diagnosis, and I've heard differing opinions.

Example: A patient has Hidradenitis Suppurativa (a chronic condition, not at goal). They come in and get an injection to three active lesions. The provider also instructs the patient to continue their current meds, and prescribes a new prescription for antibiotics. Would you add an E/M for the prescription medication management?

Example 2: The patient comes in for cryotherapy to painful warts on the fingers. The provider instructs the patient to apply salicylic acid to the warts after the cryo heals. Would you add an E/M here?

I would appreciate any guidance regarding trickier E/M situations like this.

Thanks!

For the second CASE no E&M, 1ST case 99214

 

[jkyles]

Hello all. I work in dermatology and so I see a ton of use of the 25 modifier. I'm still not quite sure what counts as significant and separate when the procedure and E/M have the same diagnosis, and I've heard differing opinions.

Example: A patient has Hidradenitis Suppurativa (a chronic condition, not at goal). They come in and get an injection to three active lesions. The provider also instructs the patient to continue their current meds, and prescribes a new prescription for antibiotics. Would you add an E/M for the prescription medication management?

Example 2: The patient comes in for cryotherapy to painful warts on the fingers. The provider instructs the patient to apply salicylic acid to the warts after the cryo heals. Would you add an E/M here?

I would appreciate any guidance regarding trickier E/M situations like this.

Thanks!

Hi there, the "cross out test" is a fairly easy way to tell whether the work rises to the level of a separate visit. Take the note, cross out everything that is related to the procedure (including typical pre- and post-procedure work) and see what you have left.