Modifier 25 Use

Modifier 25 Use

March 15, 2018

Question:
If a patient is coming in for destruction of AKs, can my doctor bill for an E/M too?  He has to evaluate the sites before doing the destruction.

Answer:
If a patient is scheduled for the minor procedure, then the decision to perform it has already been made.  When the patient presents for the procedure, it is common medical practice for the area(s) to be assessed and to have a discussion with the patient regarding them before performing the procedure.  In every surgical CPT code, there is an E/M service paid in the global package.  In order to bill an E/M separately with modifier 25, the documentation needs to support that the E/M service went over and above what is normally done for that minor procedure.  In your case, since the decision has been made, and the patient has no other complaints, only the minor procedure should be billed.

*This response is based on the best information available as of 03/15/18.

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