Forum - Questions & Answers

Sep 28th, 2015 - TerryC 39 

E/M with lesion removal HELP!

A patient was seen by the doctor and told to come back for lesion removals. She made her next appt on the day she was first seen. She came back 10 days later for the removals. I don't think another office visit can be charged since this was just already noted and pt was told to come back. The doctor is now charging a 99215 along with the removals. Is this incorrect. I believe I have seen this written somewhere but not I can't find it. Thank you
ps. If this is so, any idea where I can find it written.

Sep 28th, 2015 -

re: E/M with lesion removal HELP!

For the providier to report a E&M service on the same day as a procedure he must append a modifier 25, which per CPT® guidelines states that the patient's condition required a signficant, separately identifiable E&M code beyond the usual level of servie required for the procedure. . The modifier denotes that the patient's condition required services that were above and beyond the usual preoperative and postoperative care associated with the the acutal procedure being perfomed.

I doubt very seriously that the provider provide any other services in the E&M level that states that. Futher more he is commiting fraud as he is billing for services he has already provided at a previous session. If you look in front the CPT® book it states how modifiers are used and the definition of them. they are also in Appendix A of the CPT® book(pg 483 in the standard edition CPT® book) and the correct use of them along with a more descriptive definition.

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