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E & M codes

Kerry Posted Tue 08th of May, 2012 14:30:42 PM

What is the protocol for billing an E & M codes in addition to a bx of a skin lesion or a mole removal for a new patient? Is it up to the discretion of the provider?


SuperCoder Answered Tue 08th of May, 2012 14:48:41 PM

It totally depends upon the provider's documentation. There are different levels of E/M services for new patient and also POS is an important factor. If it's new patient office visit, then you should choose a code from series 99202-99205 based upon the level of key components (Hx, exam, & MDM) that should must meets or exceeds. Remember, to bill any new patient E/M services, you must need 3/3 key components. For established, 2/3 is required. If E/M is significant separately identifiable on the same day of the procedure, then you could append modifier -25 to the appropriate level of E/M service.

Kerry Posted Tue 08th of May, 2012 15:20:54 PM

I'm sorry, I probably worded that incorrectly. I know there are different levels of E/M codes. However, I have a new provider who is only billing the biopsy and mole removals without any E/M codes the majority of the time. Should she not be billing an E/M code as well when she does an initial evaluation?


SuperCoder Answered Tue 08th of May, 2012 16:14:27 PM

If the day of initial evaluation is for biopsy and mole removal, then only biopsy code should be billed. If on the same day, biopsy is done, and different session, patient comes for different reason on the same day, not related to biopsy removal, then E/M code should be billed with modifier -25.

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