Forum - Questions & Answers
Modifier 25
If a patient comes in with acne and a skin lesion that needs biopsy can I use the modifier 25 for acne and do the biopsy for the separate skin growth on the same day?
Absolutely!
Link the E&M to acne with the -25 and link the biopsy procedure code to the lesion diagnosis- wait til the path comes back so you can code it properly- benign v. malignant.
Modifier 25
If an E/M service was performed and the documentation supports this service was for the acne, then yes - you may bill an E/M service on the same day as the skin biopsy. You would not need to wait for the pathology report unless you removed the entire lesion. If the lesion was biopsied, and you're waiting for a result, you can bill the skin biopsy CPT. Use diagnosis 239.2 for it, because this indciates you are not aware of the lesion status, and you did not use a microscope to make a diagnosis decision for the specimen. Karen Hurley, CMM, CPC-I