Your poll questions are too simplified, so I'm not answering them.
Why was the patient scheduled? If the reason for the visit is a "suspicious lesion" and during the E/M you decide to perform MOHS and you can do it immediately, then yes you can use the -25 modifier.
If the reason for the visit is to have the MOHS procedure, then no you cannot separately bill the E/M (unless it is significant and separately identifable - see below). EVERY procedure includes payment for the appropriate Evaluation/managment of the patient. You are ALREADY being paid for the E/M when you are paid for a procedure.
If you perform a significant, separately identifiable E/M on the same date as a procedure, you can code for the E/M with -25 modifier (for a procedure with 10-day global) or -57 modifier (for procedure with 90 day global when decision to perform procedure made at that E/M visit).
Hope that helps.
F Tessa Bartels, CPC, CEMC
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