Hi. I need an opinion on the usage of modifier 25. Would anyone code an EM visit for xerosis in addtion to 11720? If so, please specify EM level. MCR guidelines. Pt over 65. (11057 does not meet mcr guidelines based on doc, no "systemic disease documented").

Chief Complaint: Onychomycosis, hyperkeratoses
Uses Carmol-40. Hasn't been using his cream for his dry feet/
calluses. Denied DM.

PMH: Pertinent

EXAM:
NAD
PEDAL PULSES: Palpable DP/PT 2 SEC. CAPILLARY FILL TIME
SKIN and TOENAILS:
Color: good.
Condition:
No ulcers, T. pedis but (+) xerosis and lesions listed below.
Q-9: Skin/texture/color changes, claudication, paresthesia
Hyperkeratosis: Distal clavus 3 RT and
RT: Submet 1, 2 3 and distal clavus 3rd.
LT: submet 1, 2 4
Thick, yellow/ whiet discoloration/striations aonly requiring minimal
debridement < 5 toenails today.
ORTHOPEDIC: HAV/ bil. and Cavus foot type/ BILATERALLY

Impression:
l. Hyperkeratoses x 7, including porokeratoses.
2. Onychomycosis x 5 requiring tx today.
3. Pain in Limb
4. Xerosis bil.

Plan:
l. Pared, enucleated 7 lesions bil.
2. Debrided, reduced 5 toenails,
3. Strongly recommended twice: BID Carmol-20 to feet; not occasionally

Thanks,

Christy CPC, RHIT