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Sebaceous Cyst

William Ivan Posted Mon 19th of May, 2014 14:02:40 PM

How would I properly bill this procedure listed below? and can I bill this in conjunction with an office visit if the only reason the patient is there is for the removal of the sebaceous cyst?

Sebaceous cyst- After informed consent was obtained the area was prepped with Betadion and anesthetized with Lidocaine/epi- lesion incised with sterile instruments- cebum obtained- cyst body removed intact- Wound tx with abx ointment and steri-strips.

SuperCoder Answered Tue 20th of May, 2014 08:00:15 AM

When submitting an E/M claim with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the same day as another service or procedure, the physician must -appropriately and sufficiently- document medical necessity for both the E/M service and the other service or procedure, according to CMS Transmittal 954, issued May 19.

If you can't show that the E/M service exceeds the -inherent- E/M component of any other services or procedures performed on the same date, you shouldn't be reporting the E/M service separately -- either with or without modifier 25.

Code skin, benign lesion excision as per the area and size given in the OP report for the sebaceous cyst.

William Ivan Posted Tue 20th of May, 2014 15:28:42 PM

What specifically should I use as the CPT code?

SuperCoder Answered Tue 20th of May, 2014 15:56:56 PM

Please give me the size of sebaceous cyst and the area where it is located.

William Ivan Posted Fri 30th of May, 2014 12:44:21 PM

Thank you.
For the cyst, the location was the upper back and the size was 5cm
For the skin nodule, the location was upper left shoulder and the size of the nodule ws 4-6cm

SuperCoder Answered Fri 30th of May, 2014 16:05:03 PM

11406-59 respectively.

William Ivan Posted Sat 31st of May, 2014 09:54:19 AM

Thank you

SuperCoder Answered Mon 02nd of June, 2014 09:57:01 AM

You are welcome!

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