Ak Removals: 17000-17111 With 99201 Can Fetch $120

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Here are three tips for your E/M and lesion removal procedures.


When your dermatologist carries out an evaluation/management service with actinic keratoses (AK) removal, you can report both the E/M and lesion removal if the E/M service was an important and separately identifiable service.


But watch out: Prior to appending modifier 25 (significant separately identifiable E/M service by the same doctor on the same day of the procedure or other service) to the E/M code, make it a point to check with your carrier, always.


You can think about appending modifier 25 only when coding an E/M service. If the procedures you are reporting do not fall under E/M services, it is likely the encounter instead qualifies for another modifier.


Here are three tips to help you report these services properly so that your practice won't miss out on about $41 for 99201 and $80 for 17000 or more, as per the national averages indicated in Medicare's 2011 Physician Fee Schedule.


Know when you should charge an evaluation/management
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Each insurer has its own guidelines for office visits (99201- 99215, Office or other outpatient visit ...) and lesion removals (17000-17111, destruction, benign or premalignant lesions). As such, knowing whether to appeal an E/M denial is tough until and unless you know that the service deserves payment.


You should report the office visit (99201-99215) in addition to the procedure when the dermatologist carries out an important, separately identifiable E/M service from the AK removal, more so if the patient is new to your practice.


Along with the proper E/M code, report any diagnoses that come with that examination, which may include more than just the AK.


Add modifier 25 to the office visit


Standard procedure is to add modifier 25 to any E/M code you report on the same day as a procedure code. Even though many insurers, including Medicare, need modifier 25 on the claims for the same-day E/Ms and procedures, not all payers mandate using the modifier. If the dermatologist does something not related to the AK such as evaluating dermatitis, you should append modifier 25 on the E/M.


Know when to report separate diagnoses


CPT and Medicare don't need different diagnoses to use modifier 25. In order to avoid later accusations of improper coding, do not change ICD-9 coding; instead, you should code accurately. And if a definitive diagnosis is not available, you can report based on symptoms.


For more on this and for other specialty-specific articles to assist your dermatology coding, sign up for good medical coding resource like Coding Institute.