Wiki well visit and wart removal

[ajones6051]

We had a patient come in for a well check and also complained of toe pain, and a wart removal was preformed. We billed the following

99393 v20.2
99212 25 729.5
17110 078.10


UHC denied the 99393 for bundling. How should I bill this to get paid for the well check?

 

[mitchellde]

Without the documentation it is hard to advise but just on the face of things here. First you do not code a definitive dx with the symptom, if the wart was the cause of the pain then you bill only the wart. Second it does not sound as if you have enough documentation to support the 99212 with then25 modifier. If the evaluation of the pain was limited to the area of the wart and the decision to remove it then that all,inclusive to the removal. Anything over above and beyond is inclusive to the we'll visit. You cannot use exam elements for both services, so it is either a well check with a wart removal or it is a significant office encounter with a wart removal.

 

[coorbeck]

Wart removal with PE and EM same day

I agree that you probably should not be billing the 99212 along with the PE and wart removal. If the toe pain is at the site of the wart, I would definitely exclude it from your resubmission. That being said, we have been having success with adding the 25 modifier to both the PE and EM code for our pediatric cases. I know that this is not how we were trained, but it is how many of the insurers are expecting the claim, and UHC is one that instructs us to do it that way. Good luck! ~Chris Oorbeck Integrity Medical Billing Service

 

[laauserc1]

In my experience, coding the well visit with modifier 25 and then the wart removal would be fine. I can not see adding a level two if there were not other acute issues. Adding the modifier to the well visit and e/m will only bypass and editing system. Just remember, this gives the insurance company an excuse to do auditing. Just a thought.

 

[coorbeck]

That's correct. You would definitely need to append the 25 modifier to the PE code in order to get both the PE and the wart removal paid. Otherwise they will pay the lowest valued procedure only.

Always check with the insurance company for policy variances. If you participate with them, you must comply with their policy decisions regardless of CPT rules.

 

[Cynthia Hughes]

You may be able to verify if modifier 25 is required on the 99383 when reporting only codes 99383 and 17110 using the United Healthcare Claims Estimator (https://www.unitedhealthcareonline....elId=a017e61156251110VgnVCM100000c520720a____). This does require creation of a user ID and password if your practice does not already have one.