Results 1 to 7 of 7

Modifier 25 - Patient sees dermatologist for skin

  1. Default Modifier 25 - Patient sees dermatologist for skin
    Medical Coding Books
    Please let me know your thoughts on the following.

    Patient sees dermatologist for skin lesion and the decision is made to remove lesion either by excision or cryo. The physician is doing what he calls a waist up exam looking for other lesions. Documentation reflects only "waist up exam ok” and description of cryo/excision procedure.

    Now for my question. Would it be appropriate for that doctor to bill a 99212-25 for that waist up exam?

    Thank you,
    Linda CPC

  2. Default
    I'll offer my two cents. If the dermatologist is examining the patient for similar lesions as he removed in his procedure would that be considered separately identifiable and distinct? He did perform a "piece" of an exam on a different part of the body, so I would consider giving him credit for it.

  3. Default
    Yes as you said he did do a piece of an exam. I have a hard time with the medical necessity of that piece. Would it be considered screening or due to the fact that the patient has this one lesion on back would that then give him the necessity to exam other skin areas?
    Thanks for your reply,

  4. Talking
    If The Doctor Did Remove Lesion Use A Modifier 25.. Then He Would Get Paid For The Office Visit And The Lesion Removal..

  5. Default
    I suppose it could depend upon what the patient's history and age is and if the physician felt it necessary to check for potential abnormalities. You asked a challenging question. Medical necessity, as you have indicated, is usually a gray area.

  6. #6
    Does the removal of the lesion CPT code carry a 10-day global? This determines the use of the -25 versus a -57.

  7. #7
    Default Waist Up Exam
    If the doctor only documents "waist up exam" without listing each area examined, NO I would not code an office visit on a new patient because you will not have the required 3/3. If established, must have 2/3.

    See for new vs established patient for modifier 25.



Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.