Wiki Simple repairs (12001 and 17000) & E&M....

[dirctn2pnt@outlook.com]

If a pt comes in for a hand wound or warts ect, can you bill the appropriate E&M level with the modifier 57, plus the CPT code for the surgical procedure.

Say a 99213-57
12001
90471
90702

Insurance is denying the ov as inclusive, cci edits show it is not mutually exclusive....

I know what the cpt surgical package states... looking for clarification.

Sara and Danielle
coders at our office.
THANK YOU

 

[msjoy216]

repairs (12001 and 17000) & E&M

If I'm not mistaken the correct modifier to use would be 25 so it would not deny as inclusive. ie 99213-25, 12001, 90471, 90702.

Hope this helps

Crys

 

[FTessaBartels]

Significantly separate E/M

Actually the basic evaluation & management of the problem is INCLUDED in the RVUs for the procedure. So unless you have a significant separately identifiable E/M (e.g. also treated HTN or runny nose) I would not code ANY E/M service.

You wouldn't use the -57 modifier because the procedure is not "major" surgery (90-day global).

F Tessa Bartels, CPC, CEMC

 

[dpeterson39]

If the decision for minor surgery was made on the same date then append the -25 modifier to the e/m for minor procedures. The only time the e/m is bundled is if the decision for surgery was made during a previous visit. Check out the AAFP website through Google or your search engine of choice. I would post the link but do not want to go against the AAFP's copyright. Another good place to look is CMS or your local Medicare Carrier's site.