Just so I'm sure I understand ...
We have a scheduled cosmetic procedure
An E/M to evaluate a lesion of concern
NO procedure on the lesion of concern?
If you are not submitting the cosmetic procedure to insurance at all, then there is no need for a -25 modifier on the E/M because the procedure will not exist as far as the insurance is concerned. (Strictly self-pay, in advance, is policy for most cosmetic procedures.)
If you are also performing a procedure on the lesion of concern, then you'd want either a -25 or a -57 depending on what you're doing and the global period involved with the procedure.
F Tessa Bartels, CPC, CEMC
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join