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ov and destruction codes

  1. Default ov and destruction codes
    Medical Coding Books
    I'm excited to be a member again!!!-
    I'm working in Dermatology. It's a new world.

    I'm wondering if anyone has seen any documentation or have experience with coding the following

    OV- 99202 with 25 mod- totally separate e/m on the same day of procedure

    with 17110 Destruction Benign Lesion with the same diagnosis (078.10 viral wort) Documentation does not support the 25 mod

    One of our Physicians stated he saw somewhere that he has to charge the ov with the procedure, I've have found nothing to support that fact.

    I do however feel he can charge the ov with the procedure but not with the 25 mod and when he does , the ins may deny payment. So far, the ins has pd a small portion on ov leaving pt a copay. The patient is not to happy, because they'vebeen coming in on regular basis to have destructions.

    I appreciate any help.

    Thanks
    Janet Ralph
    jralph@tennriverderm.com

  2. #2
    Location
    Toms River, NJ
    Posts
    51
    Smile
    Hi Janet, i do work for a dermatology group and if the pt came in just for the destruction then you cannot bill the o/v. however as in most cases if the pt was examined and then it was determined the wart need to be removed you are then able to bill the o/v with the 25 modifier using the same diagnosis. you would then bill the correct e & m code based on medical notes. hope that helps

  3. Default
    On the day of a Minor procedure ( 0-10 day global), the physician may need to indicate that the patient's condition required a separate and significant E/M service, above, and beyond the normal preop and postop service for the procedure. Does the recod documentation support this circumstance? If No, code the minor procedure only without the E/M service or the -25 modifier. If yes, Code E/M with -25 modifier. A different diagnosis is not required for reporting the E/M service on the same date. Verify medical necessity of the separate E/M service.

  4. Default
    I use a -57 on the OV. I only use -25 if there are different Dx.

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by beetuff View Post
    I use a -57 on the OV. I only use -25 if there are different Dx.
    57 is the decision for major surgery...

    CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period

    Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may not pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period.

    As for modifer 25...a different diagnosis is not required per CPT and Medicare

  6. Default
    I am confused. It is coded as new patient office visit, but the patient states that they have been coming in on a regular basis to have destructions. If the patient is coming in to have destructions and it is not a new patient, then you would not code for an office visit because that is what the patient is coming in for. However, if it was not set up for a procedure only visit, then you can code for the office visit if there is a separate exam done.

    Quote Originally Posted by Janet Ralph View Post
    I'm excited to be a member again!!!-
    I'm working in Dermatology. It's a new world.

    I'm wondering if anyone has seen any documentation or have experience with coding the following

    OV- 99202 with 25 mod- totally separate e/m on the same day of procedure

    with 17110 Destruction Benign Lesion with the same diagnosis (078.10 viral wort) Documentation does not support the 25 mod

    One of our Physicians stated he saw somewhere that he has to charge the ov with the procedure, I've have found nothing to support that fact.

    I do however feel he can charge the ov with the procedure but not with the 25 mod and when he does , the ins may deny payment. So far, the ins has pd a small portion on ov leaving pt a copay. The patient is not to happy, because they'vebeen coming in on regular basis to have destructions.

    I appreciate any help.

    Thanks
    Janet Ralph
    jralph@tennriverderm.com

  7. Talking dermatology coding
    hello, and this is an unrelated (but not so much) question. i have recently entered the world of dermatology, and have noticed that my docs on numerous occasions, will perform a destruction 17004 (10 day global) and then another destruction (17004) or procedure (16003) before that global period is up. am i able to bill the second procedure using the modifier 78?

  8. Default
    Quote Originally Posted by Janet Ralph View Post
    I'm excited to be a member again!!!-
    I'm working in Dermatology. It's a new world.

    I'm wondering if anyone has seen any documentation or have experience with coding the following

    OV- 99202 with 25 mod- totally separate e/m on the same day of procedure

    with 17110 Destruction Benign Lesion with the same diagnosis (078.10 viral wort) Documentation does not support the 25 mod

    One of our Physicians stated he saw somewhere that he has to charge the ov with the procedure, I've have found nothing to support that fact.

    I do however feel he can charge the ov with the procedure but not with the 25 mod and when he does , the ins may deny payment. So far, the ins has pd a small portion on ov leaving pt a copay. The patient is not to happy, because they'vebeen coming in on regular basis to have destructions.

    I appreciate any help.

    Thanks
    Janet Ralph
    jralph@tennriverderm.com

    The office visit is seperately billable for a first visit to decide on a plan of care. If future visit require a change in that plan then an office visit can be coded again with the procedure. If a patient comes in for a planned procedure then no office visit can be coded.
    Dee
    CPC, CPCO, CPMA, CPCD

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