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Billing in Dermatology: A Quick Overview of Coding Modifiers

Part 2 of 2

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Correct dermatology billing and coding can be challenging due to the number of in-office procedures performed by dermatologists. The second part of this series will provide a quick overview of some of the more commonly utilized modifiers. Used to communicate what was performed to insurance providers.

One of the more frequently used and poorly understood modifiers is the “25” modifier. According to the Centers for Medicare & Medicaid Services (CMS), the definition is: a significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service.

The “25” Modifier

What does this truly mean? Physicians will often attach a “25” modifier to any E/M code if a procedure is performed in the same visit. This is incorrect and can result in an audit. The “25” modifier can only be applied to E/M codes. The best way to conceptualize the “25” modifier is to subtract a procedure from a visit, and see what documentation remains. Physicians often forget included in procedure codes are pertinent history, discussion of treatment options, performing the procedure, and followup care.

The “24” and “79” Modifiers

The “24” modifier is used to indicate a separate E/M encounter during a postoperative period of a prior performed procedure. The “79” modifier is used to indicate the performance of a separate and unrelated procedure during a post-operative global period. For example, a patient who underwent Mohs with graft repair develops a rash two weeks later. The physician would need to use a “24” modifier to the office visit for the rash to indicate to insurance that this is a new and separate issue from the previous surgical procedure. If that same patient required a skin biopsy of the rash, the provider would need to use both “24” and “79” modifiers to indicate a separate office visit with a separate procedure from the graft repair.

The “59” Modifier

The “59” modifier is attached to CPT codes to indicate a procedure or service was distinct or separate from other services performed on the same day. For example, if a patient undergoes cryosurgery of 4 actinic keratoses and a shave biopsy of a mole, the biopsy CPT code 11100 would require a “59” modifier. If three procedures are performed in a single office visit, the “59” modifier would need to be applied to the second and third procedures listed. Due to perceived overuse of the “59” modifier, CMS developed four new modifiers which became effective as of January 1st, 2015.

These modifiers include: XS, XP, XU, and XE, and can be used in place of “59”. The “XS” modifier is most pertinent to dermatologists and is used to represent two procedures performed in the same encounter. But on different organs or structures. For dermatologists, this would mainly be used to indicate different anatomic locations on the skin.

Keep this article handy for quick reference and you’ll be prepared to code.

By doing a little research and keeping up with modifier changes, you’ll know you’re coding them correctly. So you can get paid for the work you’ve performed.

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