Forum - Questions & Answers

Nov 12th, 2015 - bookera08 1 

e/m with same day procedure- modifier 25

Hi a new patient went to see the doctor for a skin lesion. The doctor looks at it and decide that it needed to be removed. It was a mole that had been there for years but was crusting over and had gotten larger in size. He did labs and sent it to the pathology department. He used 99202 as the e/m code. I thought he needed to use it with the modifier 25 since he did an excision on the same day. The patient was instructed to come back in 14 days for suture removal. However, the doctor did not use another procedure code for the excision. How can I handle this???

Nov 17th, 2015 -

re: e/m with same day procedure- modifier 25

Well, unless it's a separately identifiable E/M on the same day, I wouldn't bill it. Either way, w/o modifier 25, insurance will pay the procedure and not the E/M. Remember, he/she can bill the office visit with 25 modifier if its above and beyond an evaluation of the surgical site. From what you have documented, I wouldn't apply modifier 25 though. Hope this makes sense.

Rich :)

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