Maarit Posted Wed 24th of August, 2011 16:55:33 PM
Is it appropriate for the dermatologist to perform a complete skin exam on a PT who comes for a follow-up visit 2 months after having received cryo therapy on actinic keratoses. I see charges coming through for such visits as 99212 -25 and 17000 (if additional cryo is done). I wonder if we should bill for the cryo alone, and not for the E/M level. What do you think?
SuperCoder Answered Wed 24th of August, 2011 21:38:08 PM
Since the CPT 17000 has a global period of 10 days, so when the patient comes in for a follow-up after 10 days, the doctor take chances of documenting one or two additional lines to get additional payment for E/M in addition to 17000. But, the documentation should be justified enough to separately billable with modifier 25.
In appropriately billing E/M with modifier 25 along with a procedure has also caught attention of many during Audits. With recent inclusion of CPT 99214 and 99215 as codes for Pre-payment edits in many states, if the volume of inappropriate billing of 99212-25 and 17000 increases in frequency, then the denial rates would also increase in 99212-25. So, Medicare may not take it granted that everytime the doctor bills 17000, he should bill an E/M too.