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Thread: Simple repairs (12001 and 17000) & E&M....

  1. #1

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

    AAPC: Back to School
    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

    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.

  2. #2

    Default 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


  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default 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
    Last edited by FTessaBartels; 05-12-2009 at 04:11 PM.

  4. #4
    Join Date
    Apr 2007
    Urbana, IL


    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.
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

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