Topic Thread

1.  Modifier

Posted 09-05-2017 10:29 AM
A new patient presents for hair loss and is diagnosed with alopecia areata. Intralesional triamcinolone is administered into the patches of hair loss. Could this be billed as a 99202 (with proper documentation) + modifier 25 for the injection?

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Heather Reagin
UNTHSC
Fort Worth TX
(817) 735-2799
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2.  RE: Modifier

Posted 09-05-2017 10:31 AM
If the evaluation and management service is performed and documented, the appropriate level of E/M may be reported with modifier 25.  In addition report the intralesional injection and drug without a modifier.

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Cynthia Stewart, CPC, CPMA,COC, CPC-I
Manager, Coding Resources
American Academy of Dermatologist
Schaumburg, IL
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3.  RE: Modifier

Posted 13 days ago
Regarding your comments concerning alopecia areata and intralesional injection, we have been told that if a procedure is performed that as part of the procedure the diagnosis and evaluation of the condition is included in the procedure code.  Therefore wouldn't the diagnosis of alopecia areata not be a separate E/M code if an intralesional injection is performed?

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Kenneth Bielinski
Orland Park IL
(708) 636-3767
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4.  RE: Modifier

Posted 13 days ago
Thank you for requesting clarification of this post. In the original question, the encounter was for a new patient with alopecia areata, which unfortunately is still considered cosmetic by most payers. As we understand, most payers will allow for payment of the initial E/M for this condition. The injection most likely will be denied as a cosmetic service.

Reporting of an E/M in addition to a minor procedure such as a biopsy, requires documentation that identifies a significant separately identifiable E/M service above and beyond the usual preservice and post-service care associated with the procedure performed.

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Cynthia Stewart, CPC, CPMA,COC, CPC-I
Manager, Coding Resources
American Academy of Dermatologist
Schaumburg, IL
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5.  RE: Modifier

Posted 13 days ago
Can you explain how this is different than performing a biopsy? If someone presents with a neoplasm of uncertain behavior and you perform an appropriate E&M service and perform a biopsy on the same day, you cannot use the 25 modifier. Can you explain how the alopecia case and intralesional triamcinolone is different?

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Heather Reagin
OPTI/UNTHSC
Fort Worth TX
(817) 735-2799
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6.  RE: Modifier

Posted 13 days ago
Thank you for requesting clarification of this post. In the original question, the encounter was for a new patient with alopecia areata, which unfortunately is still considered cosmetic by most payers. As we understand, most payers will allow for payment of the initial E/M for this condition. The injection most likely will be denied as a cosmetic service.

Reporting of an E/M in addition to a minor procedure such as a biopsy, requires documentation that identifies a significant separately identifiable E/M service above and beyond the usual preservice and post-service care associated with the procedure performed.

------------------------------
Cynthia Stewart, CPC, CPMA,COC, CPC-I
Manager, Coding Resources
American Academy of Dermatologist
Schaumburg, IL
------------------------------