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Modifier 25

  1. #1
    Default Modifier 25
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    Patient has a skin biopsy and it is sent for pathology. The pathology returns malignant. The patient returns to the office and the wound site is checked for healing, signs of infection and or discharge and the pathology results and treatment options are reviewed with the patient. It is decided that destruction/excision is performed that day.

    Question: Is this work considered above and beyond the standard pre-procedure work to justify a E/M billed with a modifier of 25.

  2. #2
    Default
    We would have coded skin biopsy- 11100. We would notify the patient of the path results and determined a future treatment plan. If they came back in, we would have charged an E/M level with a 25 modifier along with the excision procedure performed. Depending on the excision procedure- 11400-11646- these are global and will put the patient into a ten day global for all post-op visits. Usually, insurance pay for the whole surgical package depending on the diagnosis and we would also let the patient know they will probably get a bill from the pathologist as well.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Default
    I also found this if this will help you. Happy coding!

    Procedures such as biopsies (CPT codes 11100, 11101), shave removals (CPT codes 11300 through 11313), intralesional injections (CPT codes 11900, 11901, 96405, 96406), and Mohs (CPT codes 17311 through 17314) have no postoperative period. This means that if the patient requires a follow-up visit immediately after the procedure for services such as dressing changes, wound checks, and/or suture removal, the visit should be billed as an E/M visit. No modifiers should be needed on the E/M visit unless some other procedure is billed on the same date of service or there is a follow-up period in place because another unrelated surgical service was performed.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

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