Forum - Questions & Answers
modifier 25
I just read one of the articles in the entry section that stated if a patient is seen in the office for possible bleeding hemorrhoids, and an anoscopy is performed, then the E/M with modifier 25 can be billed with the anoscopy CPT code. I was always under the impression that anoscopy was part of the examination. Am I incorrect on this, and have I been letting an extra 35 bucks slip through my near bankrupt fingers?
It is a procedure and should be billed with the E&M and -25 on the E&M
The lubricant probably contributed to that $35 slipping out of your fingers.
modifier 25
good one signaturedoc!
Yes, there are some cases when a visit code with a modifier -25 can be used, but it won't be with every patient.
Every procedure has some level of E/M built into it, so your normal work up before a procedure is inclusive. If the patient came in already knowing this scope was planned, its probably not billiable.
If the patient was referred to you for evaluation, and you examined, and then made the decision that this scope needed to happen, you may be able to bill.
Not every "decision" justifies the E/M code...so just make sure your documentation displays the "above and beyond" work you did.
anoscopy
I think that in almost every situation, there must be a separate evaluation to perform an anoscopy. It's not like a patient arriving with warts and saying, "Hey, I have warts, can you destroy them?" For an anoscopy, the patient arrives with a complaint that needs to be evaluated. I would bill for it in addition to the E/M.