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Cosmetic procedure and E&M

  1. #1
    Default Cosmetic procedure and E&M
    Exam Training Packages
    Is it appropriate to append -25 to 99212-99214 when the patient is in for a cosmetic procedure and an E&M is done on a separate issue, such as a lesion of concern? If anyone could provide a source it would be most appreciated by a new coder. Thank you!
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  2. #2
    Milwaukee WI
    Default No additional procedure done?
    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

  3. #3
    Thank you for your response!

    Yes, it would be a scheduled cosmetic procedure which is self-pay and not covered by insurance. During the procedure the customer/patient mentions the lesion of concern. After evaluation, it is determined to destroy the lesion or shave/excise the lesion.

    Scenario #1 - new appointment is made to destroy or excise the lesion or perform a biopsy. No -25 is needed on the E&M since the insurance company does not provide coverage for cosmetic procedures. Is that correct?

    Scenario #2 - procedure is done on the lesion during the encounter for the cosmetic service. Would it be appropriate to append the -25 since the E&M was performed in addition to the biopsy/destruction/excise of the lesion during the same cosmetic service visit?

    What documentation and/or source would I quote to the doctor to backup these coding procedures?

    Thank you again!
    Trish - new coder

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